Evidence-Based Nursing Discussion
DISCUSSION BOARD INSTRUCTIONS
- Post a brief statement of your proposed EB practice change, be sure to address how you will implement your EBP project considering,
- 1) Understanding the differences,
- 2) Considering your resources,
- 3) Establish your patient-centered goals, and
- 4) Identify institutional preferences and how you will address this issue.
- Evidence-Based Nursing: The Research-Practice Connection 4th Edition by Sarah Jo Brown (Author)
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EBP Impact Model Design Phase
In the context of Evidence-Based Practice (EBP) using the “Impact Model” developed by Brown, the “Design” phase refers to the stage where the specific intervention or practice change is meticulously crafted, considering the identified problem, relevant evidence, and the unique context of the target population, with a focus on maximizing potential impact and aligning the intervention with the desired outcomes.
Key elements of the Design phase in the Impact Model EBP:
- Problem definition:
Clearly articulate the problem or clinical issue that the intervention aims to address, including its scope and significance within the target population.
- Evidence review:
Conduct a comprehensive literature search to identify the most relevant and robust research evidence supporting potential interventions to tackle the identified problem. Evidence-Based Nursing Discussion
- Intervention development:
Based on the evidence, design a specific intervention with clearly defined components, implementation strategies, and measurable outcomes.
- Adaptation to context:
Tailor the intervention to fit the specific needs and characteristics of the target population and setting, considering local factors like organizational culture, resource availability, and stakeholder perspectives.
- Feasibility assessment:
Evaluate the practicality of implementing the intervention, considering potential barriers and facilitators within the context.
- Implementation plan creation:
Develop a detailed plan outlining how the intervention will be rolled out, including timelines, responsible parties, training protocols, and monitoring mechanisms
ASSIGNMENT INSTRUCTIONS
- Develop a plan to overcome barriers. Your plan should be clear and specific. Another person should be able to read your plan and replicate it.
- Discuss with colleagues.
- Describe the anticipated barriers to the change process in your institution (or where the change will be implemented). Include the organization’s culture, its reaction to change, and your leadership role for a change.
- Identify the stakeholders for the change in practice you have chosen for your EB project. This is NOT a paper. Use the table provided on the Assignment page to complete this assignment. Evidence-Based Nursing Discussion
- Please fill out the Barriers Form, there are 2 forms attached
| State your proposed EB practice change. | The proposed evidence-based practice (EBP) change involves implementing the Psoriasis Epidemiology Screening Tool (PEST) as a routine screening measure in dermatology and outpatient departments for use in all patients presenting with psoriasis symptoms to enhance the early detection of Psoriatic Arthritis (PsA). The proposed change aims to reduce diagnostic delays by identifying high-risk patients and ensuring timely referrals to the rheumatology department for treatment. The project will integrate PEST into electronic health records (EHR) for ease of administration, flagging positive results, and following up with referred patients.
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| Describe the anticipated barriers to the change process in your institution (or where the change will be implemented). Include the organization’s culture, anticipated reaction to change, and your leadership role for change. | Introducing the PEST questionnaire into my institution will likely present several barriers to the change process. These barriers include time and financial constraints, inadequate staff, resistance due to anticipated workflow interruptions, and inadequate organizational support. Thus, there may be limited time and finances to incorporate the PEST questionnaire into the system as a routine practice. Additionally, there may be inadequate staff to handle the screening, considering the institution already has a staff shortage. Staff may also be resistant to change due to the fear of having their workflow disrupted or having additional work. Evidence-Based Nursing Discussion
The organizational culture entails prioritizing clinical efficiency; hence, staff may view the PEST screening tool as an additional workload that may negatively impact care efficiency. Staff and institutional administrators are anticipated to resist the change, citing time constraints, being unsure of the tool’s efficacy, and the need to incorporate PsA screening into the departments. My leadership role for change in this project entails advocating for change by educating on the importance of PsA screening in addressing delayed diagnosis and facilitating communication between departments involved. |
| Plans to overcome barriers | The plan to overcome the anticipated barriers identified above will entail several strategies. These include training, education, workflow integration, communication, and staff support. According to Dang et al. (2021), adequate planning and gaining support and buy-in from institutional administrators overcome time and financial constraints in EBP projects. Training and education sessions will also be offered to the staff to demonstrate the significance of early PsA diagnosis and use the PEST questionnaire effectively. The team will also incorporate PEST seemingly into the existing workflows, embedding it into the HER systems. Communication is also essential in addressing and overcoming anticipated barriers. The implementation leader will share the project progress with the staff and address any issues raised on the same. Staff will also be supported by providing project feedback and acknowledging how their contribution directly impacts patient outcomes. |
| Who are the colleagues you will include to facilitate change? | The successful implementation of the EBP change requires collaboration among different colleagues (Bauer &Kirchner, 2020). The colleagues I will include in this project include dermatologists, other nurses and medical assistants, rheumatologists, IT specialists, and the quality improvement team. The dermatologists, nurses, and medical assistants will adopt the PEST questionnaire into their routine practice and use it to diagnose PsA patients and refer them to rheumatologists, who will provide treatment interventions for the diagnosed patients. The IT specialists will integrate the PEST tool into the HER system, while the quality improvement team will track implementation progress Evidence-Based Nursing Discussion.
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| Identify the stakeholders for the change in practice you have chosen for your EB project. | McNett et al. (2022) note that stakeholder identification in EBP change processes is vital in ensuring all affected individuals and those influencing the process are incorporated in decision-making, promoting success. The stakeholders for change in this project include the patients, healthcare providers, institutional leaders, and professional organizations. PsA patients are primary stakeholders in the project since addressing delayed diagnosis will improve patient outcomes and quality of life. The healthcare providers are also key stakeholders as they are expected to implement and adapt to the screening tool as routine practice. The institutional administrators will make decisions regarding the program, such as financial allocation, and ensure the project aligns with the organizational goals. Additionally, professional organizations such as dermatology associations may support the initiative by providing educational resources and guidelines. |
| References | Bauer, M. S., & Kirchner, J. (2020). Implementation science: What is it and why should I care? Psychiatry Research, 283, 112376. https://doi.org/10.1016/j.psychres.2019.04.025
Dang, D., Dearholt, S. L., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model and guidelines. (4th Ed.) Sigma Theta Tau. McNett, M., Tucker, S., Zadvinskis, I., Tolles, D., Thomas, B., Gorsuch, P., & Gallagher-Ford, L. (2022). A Qualitative Force Field Analysis of Facilitators and Barriers to Evidence-Based Practice in Healthcare Using an Implementation Framework. Global Implementation Research and Applications, 2(3), 195–208. https://doi.org/10.1007/s43477-022-00051-6 |
Module 4 Discussion
Delayed diagnosis of Psoriatic Arthritis (PsA) in patients with psoriasis is a well-documented issue, leading to worsened disease progression, functional impairment, and decreased quality of life (Kılıç et al., 2024)Evidence-Based Nursing Discussion. The Psoriasis Epidemiology Screening Tool (PEST), is a validated questionnaire that has shown effectiveness in identifying PsA early when applied in dermatology and primary care settings. However, its use remains inconsistent. This discussion identifies my proposed Evidence-Based Practice (EBP) change and how it will be implemented considering understanding the differences, resources, patient-centered goals, and institutional preferences.
My proposed practice change involves implementing routine PEST assessments for psoriasis patients in dermatology and primary care settings. Following positive results, structured referrals to rheumatologists will be made. The implementation will require collaboration between the rheumatology and dermatology departments. However, it is essential to understand the differences first. There may be contextual differences and workflow disruptions. For instance, the dermatology and primary care departments differ in familiarity with PsA symptoms. Additionally, PEST will be integrated into existing workflows with minimal disruption, leveraging electronic health records (EHRs) for efficiency.
Human, technological, and budgetary resources are needed to implement the proposed practice change. For instance, we must train the care providers to administer, score, and interpret the PEST questionnaire. The questionnaire also needs to be embedded into the EHR system to automate administration and identify patients requiring follow-up. Moreover, we need the institution’s budgetary support (finance provision) for training and HER modifications.
The patient-centered goal is to improve early identification of PsA, enabling timely treatment and preventing related complications such as joint damage, improving overall quality of life. However, it is essential to identify and address institutional preferences. For instance, the institution prefers practice change to be rolled out using standardized protocols and backed up by evidence. To address this, I will develop a clear and standardized protocol for PEST administration and referral to ensure alignment with institutional quality improvement and present data supporting PEST’s efficacy to the institutional administration. Evidence-Based Nursing Discussion
Implementing routine PEST screening within the dermatology and primary care departments is a practical, evidence-based approach to addressing the issue of delayed PsA diagnosis. The proposed implementation strategy will foster a sustainable and impactful EBP change to reduce PsA diagnostic delays by addressing contextual differences, leveraging available resources, focusing on patient outcomes, and aligning with institutional priorities.
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Reference
Kılıç, G., Kılıç, E., Tekeoğlu, İ., Sargın, B., Cengiz, G., Balta, N. C., Alkan, H., Kasman, S. A., Şahin, N., Orhan, K., Gezer, İ. A., Keskin, D., Mülkoğlu, C., Reşorlu, H., Ataman, Ş., Bal, A., Duruöz, M. T., Kücükakkaş, O., Şen, N., Toprak, M. and Nas, K. (2024). Diagnostic delay in psoriatic arthritis: Insights from a nationwide multicenter study. Rheumatology International, 44(6), 1051–1059. https://doi.org/10.1007/s00296-023-05479-z Evidence-Based Nursing Discussion
