Proposed evidence‐based practice project solution

Write a paper of 500‐750 words (not including the title page and reference page) paper for your proposed evidence‐based practice project solution. Address the following criteria:
Proposed Solution: (a) Describe the proposed solution (or intervention) for the problem and the way(s) in which it is consistent with current evidence. Heavily reference and provide substantial evidence for your solution or intervention. (b) Consider if the intervention may be unrealistic in your setting, too costly, or there is a lack of appropriate training available to deliver the intervention. If the intervention is unrealistic, you may need to go back and make changes to your PICOT before continuing.
Organization Culture: Explain the way(s) in which the proposed solution is consistent with the organization or community culture and resources.
Expected Outcomes: Explain the expected outcomes of the project. The outcomes should flow from the PICOT.
Method to Achieve Outcomes: Develop an outline of how the outcomes will be achieved. List any specific barriers that will need to be assessed and eliminated. Make sure to mention any assumptions or limitations which may need to be addressed.
Outcome Impact: Describe the impact the outcomes will have on one or all of the following indicators: quality care improvement, patient‐centered quality care, efficiency of processes, environmental changes, and/or professional expertise.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.
Upon receiving feedback from the instructor, refine "Section D: Solution Description" for your final submission. This will be a continuous process throughout the course for each section.
Below are the readings for this assignment:
(1) Explore the Office for Human Research Protections (OHRP) website.
URL:
http://www(dot)hhs(dot)gov/ohr
The role of a research nurse in translating evidence into practice
Houlston, Catherine. Nursing Management (through 2013); London Vol. 19, Iss. 1, (Apr 2012): 25-8. Publisher logo. Links to publisher website, opened in a new window.
Full text
Full text - PDF
Abstract/Details
Abstract
Translate
This article describes the role and experiences of a research nurse working with a nursing team to implement best practice guidelines. The structure of the research project and resources were found to support the change, resulting in better patient care. Challenges promoting change as part of a research project included inflexibility of research paperwork and competing local trust priorities. The research nurse was able to support the clinical team to implement change through education and regular visits to the ward to monitor progress and feedback good practice.
Full Text
Translate
Headnote
Catherine Houlston describes her experience of working alongside ward staff to implement an intervention based on best practice guidelines, which included providing education sessions and monitoring progress through audit
Abstract
This article describes the role and experiences of a research nurse working with a nursing team to implement best practice guidelines. The structure of the research project and resources were found to support the change, resulting in better patient care. Challenges promoting change as part of a research project included inflexibility of research paperwork and competing local trust priorities. The research nurse was able to support the clinical team to implement change through education and regular visits to the ward to monitor progress and feedback good practice.
Key words
Research nurse, implementing change, evidence
Applying evidence to clinical nursing practice can improve patient outcome and quality of care (Mantzoukas 2009). However, the challenges of implementing change in clinical areas have been widely reported (Gerrish and Clayton 2004, Hutchinson and Johnston 2004, Solomons and Spross 2011).
Educating clinical teams about the findings of a study is acknowledged to be part of the role of a research nurse (Roberts et al 2006, Bell 2009). Where research requires a significant change in nursing practice, the research nurse may also have a role in engaging and motivating staff (Spilsbury et al 2008, Roberts et al 2011).
This article explores the role of the research nurse in supporting changes in practice and discusses how clinical teams benefit from participating in research. However, the nature of the change in practice will not be discussed here because the project is part of an ongoing trial and therefore subject to reporting restrictions. The implementation of the change is ongoing and continuing to evolve to meet practice needs.
Background
The ward project was part of national research and involved the introduction of an intervention by the nursing staff based on best practice guidelines. Senior ward staff were motivated to participate in the project because it centred on an area of practice they wanted to improve. The ward had a history of successful change management and staff willing to lead the change.
The research nurse had worked elsewhere in the trust before being employed to work specifically on the project. The appointment was made with the expectation that the nurse would support the ward team to implement change, as well as have responsibility for running the study in the hospital.
The research nurse has a role in improving the research study by ensuring adherence to research protocols (Spilsbury et al 2008), and successful implementation of the change was required in this study to enable robust and meaningful data collection.
Challenges
Conflicting priorities The need for protected time for staff to promote and lead change is commonly reported as one of the greatest barriers to translating evidence into practice (Gerrish and Clayton 2004). The senior nurses taking part in implementing the research were simultaneously involved in other various trust initiatives.
This meant that trust managers were putting them under pressure to prioritise crucial trust targets while they were trying to meet the demands of the research team.
It was recognised that the intervention the study centred on could affect staff workload and there was funding for extra healthcare assistants (HCAs) to support the intervention; this benefited the team, but fluctuating clinical pressures and priorities meant that, at times, they found it difficult to protect their role of supporting the intervention.
One problem that was particularly difficult to resolve was that of providing staff time for education away from the clinical area. Education sessions planned by the research nurse were frequently rearranged because staff were required to attend meetings and training sessions relating to other trust requirements. These other trust initiatives were often prioritised by senior staff and managers, requiring the research nurse to be flexible and to explore other learning opportunities wherever possible.
Documentation It was found that some aspects of the research study overlapped with trust requirements, particularly in terms of documentation. Compliance with filling in the research paperwork was sometimes hindered because staff were having to record the same information more than once.
There is evidence that using staff feedback during the process of change can bring about success (Cummings et al 2007). Ideas from staff to make the documentation more acceptable revolved around changes to the content and format. These suggestions, however, were not appropriate because the document was an evidence-based assessment and the unit was part of a cluster randomised trial.
One piece of documentation that the registered clinical staff had to complete was considered by them to be labour intensive and a significant obstacle to engaging them with the study. This was an initial patient assessment that had been developed in line with best practice. Resources had been provided to backfill the time taken to complete the document, suggesting that the some of the difficulties with the paperwork may have been as much about changing practice as time constraints. This was challenging to resolve, although the clinical leads for the project were able to develop methods to help improve compliance.
Role of the research nurse
Education has been identified as part of research nurses' roles, but educating staff about a new protocol is unlikely to be sufficient to change practice. Successful change depends on a range of factors that include leadership and workplace culture (Cummings et al 2007, Kitson et al 2008, Gifford et al 2011).
To support the change process, senior ward nurses who could influence practice in the clinical area and who were motivated to improve patient care were identified at the start of the project.
The research nurse did not have the same multiple demands and clinical pressures as the ward staff, and was able to focus on the project. This enabled her to provide practical support and assistance to the ward team with implementing the intervention. Initially, the research nurse focused on raising awareness of the importance of the research topic, as well as providing formal and informal teaching about the study itself.
The research project did not start immediately after the research nurse came into post because the team needed to recruit HCAs before data collection could begin. While this had financial implications for the project, it did allow the research nurse time to familiarise herself with the specialty and the staff.
It was at this point that the research nurse recognised the many benefits of working clinical shifts alongside staff, which included informal teaching about the importance of the project. On a practical level, supporting staff with their clinical workload made it easier for them to make time to attend teaching sessions and meetings about the project. It was also easier to acknowledge and solve problems raised by staff with knowledge of how the ward currently worked.
Barriers to research use have been described as a perception that its benefits may be minimal or not relevant to practice (Hutchinson and Johnston 2004, Roberts et al 2011). When delivering informal teaching, the research nurse was able to use knowledge of patients on the ward to illustrate potential benefits for them, reinforcing the relevance of the study. Raja-Jones (2002) states that a research nurse may be seen as elitist, often linked with academic institutions away from the clinical environment. However, the research nurse benefited from working clinically alongside staff because she was able to engage staff in the project.
Spilsbury et al (2008) stress that it is important for research nurses to be a regular presence on wards that are taking part in nursing research studies. The nature of the change in practice meant that attending education sessions alone would be unlikely to give staff sufficient confidence to make decisions relating to the protocol, and ongoing advice was required. It was therefore important for the research nurse to maintain a regular presence on the ward to help staff with problem solving through informal teaching, as well as to support clinical leads with reminding staff about their responsibilities.
It was vital that senior ward staff were also seen to be promoting the change to embed it in practice. One of the challenges for the research nurse was to establish where their roles fitted in with the leads for the project from the clinical area.
Harvey et al (2002) describe the role of a change facilitator as being task focused, from providing practical help where required to helping staff develop skills to take forward change themselves. The research nurse in this role had a range of options for supporting the ward team and regular communication was required with project leads to ensure the level of support given was appropriate for their needs.
The research nurse was able to contribute to ensuring that staff had feedback about progress, particularly where there were successful outcomes for patients. Once the study started the research nurse monitored patient progress and compliance with the intervention as part of data collection.
Gifford et al (2011) describe how successful guideline implementation requires encouragement and recognition of the contribution of staff. The research nurse was able to communicate progress during ward visits, identifying areas of good practice as well as reminding staff where there had been omissions. Positive feedback to the research nurse about nursing practice from patients and relatives was disseminated through a newsletter and poster presentation.
One of the challenges for the research nurse was to balance support for implementing the change in practice with the role of recruiting patients for the study. It would not have been possible to collect the data required without the backing of the ward staff following the research intervention, so spending time supporting and educating the team was considered beneficial for the study.
Developing 'champions' for the project was also necessary to maintain momentum on a daily basis in the absence of the project leads. The champions were staff who had been identified as having a particular interest in the project and included both registered nurses and HCAs.
Positive outcomes
There was an unquestionable improvement in the management of patients during the research project, demonstrated by regular monitoring of compliance by the research nurse. Successful outcomes and positive feedback from patients reinforced the benefits of the implementation of the best practice guidelines that had been introduced.
Sustaining the change was likely to prove a challenge for staff once the project had finished, but they were motivated to continue and hoped to adapt the documentation to reflect the needs of their clinical area.
A major motivation for staff to take part in the project was the improvement of patient care through the implementation of best practice guidelines. It was also an opportunity for staff to have an active role in research and to find ways to translate evidence into practice.
Learning about the intervention enabled staff to become experts in the area being studied. This reflects findings from Boase et al (2012) who found that clinical staff participating in delivering a research intervention recognised how the experience had enabled them to develop their practice. Implementing best practice guidelines as part of a formal research project also added credibility to what they were doing. This led to opportunities for presenting the work, increasing recognition of their achievements.
Conclusion
The nurse leading this study was ideally placed to support the clinical team in implementing the clinical guidelines, which involved supporting change through engaging and motivating staff (Spilsbury et al 2008, Roberts et al (2011).
Rickard and Roberts (2008) suggest that, where a nursing intervention is being introduced as part of a study, the role of the research nurse may be inherently different to that of a research nurse in a medical trial because the nurse is involved in encouraging compliance with the research protocol.
The benefit for the clinical area of participating in this research study included additional structure and resources provided. Some of the challenges experienced here have been cited by previous studies. The problems for clinical staff of reconciling competing priorities were similar to those described by Boase et al (2012). Implementing some of the documentation required in the clinical area was a problem, although methods were developed to help compliance.
The best practice guidelines were effectively implemented as part of the study described and there were clear opportunities for staff development. This was a significant achievement by the clinical team.
Sidebar
Trust initiatives were often prioritised by senior staff and managers, requiring the research nurse to be flexible
It was vital for the research nurse to have a regular presence on the ward to help staff with problem solving through informal teaching
Online archive
For related information visit our online archive of more than 6,000 articles and search using the keywords.
Conflict of interest
None declared
References
References
Bell J (2009) Towards clarification of the role of research nurses in New Zealand: a literature review. Nursing Praxis in New Zealand. 25, 1, 4-16.
Boase S, Kim Y, Craven A et al (2012) Involving practice nurses in primary care research: the experience of multiple and competing demands. Journal of Advanced Nursing. 68, 3, 590-599.
Cummings G, Estabrooks C, Midodzi W et al (2007) Influence of organizational characteristics and context on research utilization. Nursing Research. 56, 4 suppl, 24-39.
Gerrish K, Clayton J (2004) Promoting evidence-based practice: an organizational approach. Journal of Nursing Management. 12, 2, 114-123.
Gifford W, Davies B, Tourangeau A et al (2011) Developing team leadership to facilitate guideline utilization: planning and evaluating a 3-month intervention strategy. Journal of Nursing Management. 19, 1, 121-132.
Harvey G, Loftus-Hills A, Rycroft-Malone J et al (2002) Getting evidence into practice: the role and function of facilitation. Journal of Advanced Nursing. 37, 6, 577-588.
Hutchinson A, Johnston L (2004) Bridging the divide: a survey of nurses' opinions to, and facilitators of, research utilization in the practice setting. Journal of Clinical Nursing. 13, 3, 304-315.
Kitson A, Rycroft-Malone J, Harvey G et al (2008) Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges. Implementation Science. 3, 1.
Mantzoukas S (2009) The research evidence published in high impact nursing journals between 2000 and 2006: a quantitative content analysis. International Journal of Nursing Studies. 46, 4, 479-489.
Raja-Jones H (2002) Role boundaries - research nurse or clinical nurse specialist? A literature review. Journal of Clinical Nursing. 11, 4, 415-420.
Rickard C, Roberts B (2008) Commentary on Spilsbury K, Petherick E, Cullum N, Nelson A, Nixon J & Mason (2008). Journal of Clinical Nursing. 17, 19, 2664-2666.
Roberts B, Rickard C, Foote J et al (2006) The best and worst aspects of the ICU research coordinator role. Nursing in Critical Care. 11, 3, 128-135.
Roberts B, Eastwood G, Raunow H et al (2011) The intensive care research coordinator position in Australia and New Zealand: self perception of professional development priorities and 'best' and 'worst' aspects of the position. A cross-sectional web-based study. Intensive and Critical Care Nursing. 27, 3, 129-137.
Solomons N, Spross N (2011) Evidence-based practice barriers and facilitators from a continuous quality improvement perspective: an integrative review. Journal of Nursing Management. 19, 1, 109-120.
Spilsbury K, Petherick E, Cullum N et al (2008) The role and potential contribution of clinical research nurses to clinical trials. Journal of Clinical Nursing. 17, 4, 549-557.
AuthorAffiliation
Correspondence
catherine.houlston@
addenbrookes.nhs.uk
Catherine Houlston is practice development sister, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge
Date of acceptance
February 29 2012
Peer review
This article has been subject to double-blind review and has been checked using antiplagiarism software
Author guidelines
www(dot)nursingmanagement(dot)co(dot)uk
Word count: 2573
Copyright RCN Publishing Company Apr 2012
Cited by (2)
Infusing Nursing Research into Practice for Quality Care: [1]
Selvaambigai, V R.
Nursing Journal of India; New Delhi Vol. 103, Iss. 2, (Apr 2012): 77-78.
A Phenomenological Study of the Shared Governance Experience for Nurses Working in the Pharmaceutical Industry
Mueller, Adele.
Northcentral University, ProQuest Dissertations Publishing, 2016. 10129069.
Thinking Like a Nurse: A Research-Based Model of Clinical Judgment in Nursing
Tanner, Christine A, PhD, RN.
Journal of Nursing Education; Thorofare Vol. 45, Iss. 6, (Jun 2006): 204-11.
Teach-Back Effects on Self-Reported Understanding of Medication Management After Discharge
Silva, Laurie-Anne.
Walden University, ProQuest Dissertations Publishing, 2014. 3620736.
Building research capacity in the nursing workforce: the design and evaluation of the nurse researcher role
Chan, Raymond; Gardner, Glenn; Webster, Joan; Geary, Alanna.
Australian Journal of Advanced Nursing (Online); Melbourne Vol. 27, Iss. 4, (Jun-Aug 2010): 62-69.
Show more related items
MeSH subject
England
Health Plan Implementation
Humans
Organizational Innovation
Guideline Adherence -- organization & administration
Nurse's Role
Nursing Research
Research Personnel
Staff Development -- organization & administration
Search
Ask a Librarian
Contact UsTerms and ConditionsPrivacy PolicyCookie Policy
Cookie Preferences
Accessibility
Copyright © 2019 ProQuest LLC.