Evidence Based Research related to the Operating Room

In this task you are going to do some research at your work setting about how a CURRENT process or procedure got started and why it was put in place. Most of the paper will be about the benefits of the new process you are recommending to replace it and how you put it in place. However, you will FIRST need to answer some questions about the OLD or CURRENT process. The goal of this paper is to recommend a change to a nursing process. Here are common questions related to this task: 1. What should I use for a topic? Choose a topic that is nurse driven. Do not choose topics that require the approval of other healthcare professionals outside of nursing. The choice of topic can be related to a nursing admission or assessment process. It can also be related to a patient care or patient preparation procedure. Remember though that it is easiest to work through this paper if you have a clear old policy or process and a clear new recommended one. Do not write a paper about a process that you want to start where there has been no process in place before. Also consider choosing a topic that you have a written policy for. You will see as you work through the questions that sometimes it is easier to think about how you would change a written policy. 2. My facility has already made a lot of great changes. I can not find anything to change. What should I do? You can always write about a topic that has been changed already. If you do this, YOU MUST write as if the change has not taken place yet. You want to take your facility and yourself back in time to when the change was recommended. If you think about it, you will have a good idea of some of the answers for this paper if you use a topic that you have watched change already. 3. Do the resources need to be primary research as they are in task one? The resources in this paper do not need to be primary research, though you are welcome to use primary research in this task. Please note that the resources used in this paper will need to be recent. As a general rule of thumb in all courses, recent resources should be within the last five years. This rule is firmly adhered to in this paper. 4. I do not work in a hospital. How do I go about writing this paper? Students who work in long term care, home health, or even as school nurses have been able to find patient admission, assessment, or care policies in their work settings that need to be changed. For example, one school nurse suggested a change to the attendance policy for students with chronic head lice infestation. Think about where you work, and think about what could be improved there. It is likely you will be able to find a topic that works for this task. Another option is to discuss a familiar procedure, such as shift report or medication administration, and offer changes to the typical routine. Many students suggest changing from end of shift report at the nurses’ station to bedside report. 6. Do I need to use names of the facility or of staff members? No, you do not need the specific names of facilities or of staff members; it is preferable to use titles and committee names. Remember to avoid first person for this and all APA papers. 7. Can I use the same topic that I researched in task one? Yes, you can use the same topic that you have used in task one as long as your topic meets criteria for this paper. In this paper you will need five credible sources that are five years or less and do not need to be primary research. What follows are the directions from taskstream (typed in black) and the clarifying guidance (typed in blue) from your course mentors. Each area is a test of your knowledge on that section of material from your books. Your goal should be to show the reader the knowledge you have learned on that topic. That will mean that you want to fully explain your answer for each section of the task in five to seven sentences at least. Use the prompts from the rubric as subheadings to separate this paper into sections. Introduction: For this assessment, you will select a nursing admission/assessment or patient care/preparation process or procedure (e.g., routine shaving of the surgical site) that is commonly found in your practice setting that you and your colleagues question. You will gather evidence to determine the basis for this process or procedure, provide suggestions based on evidence on how this process or procedure should be changed, and determine possible barriers to implementation of a revised clinical practice guideline. Task Description: A. Describe a nursing admission/assessment or patient care/preparation process or procedure currently found in your practice setting. Note: You must choose a process or procedure that is already in place and you can recommend changes to. You can choose any nursing admission, nursing assessment, nursing care procedure or nursing preparation procedure. The example of routine shaving of a surgical site is provided only as an example. (We strongly suggest that you do not use the example topic, since it is a procedure that was changed years ago in most practice settings and it will be difficult to find recent sources.) 1. Discuss why the present process or procedure needs to be changed, based on the evidence you have gathered. You will need in-text citations to support the need for a change to this procedure. Describe the present process or procedure that you chose to change and give supporting information about why you believe that process needs changing. Remember to focus on the old process- that is the process that is changing. Use evidence from your five credible sources to support the need for change. Evidence means specific paraphrased information from your resources with in-text citations. 2. Based on your initial investigation of the situation, do the following: Note: You may need to ask workplace personnel. Also note it is not sufficient to say there was not a process in place before your suggested change. You must have a process to change. a. Explain who determined the basis for the current process or procedure in your practice setting. Here the evaluator will need to see the job title or the committee name of the people responsible for the decision to put in place the practice that you are recommending to be changed. You will want to describe position titles. This paragraph may be short and to the point. b. Explain the decision makers’ rationale for instituting or supporting the current process or procedure. As nurses we are very familiar with rationale. Think about this as why the practice works or is supposed to work in any similar setting. Perhaps that is a physiologic answer about a process in the body. Perhaps there is evidence about documentation, a form of assessment, or some other communication process. You may need to include in-text citations if you use a source for this section. c. Explain why the decision makers decided to implement the current process or procedure. While this may sound similar to the question above, this question is asking you why the person or the committee that you talked about in the “a” section above decided to implement this process. Section A2b was about the general research, or the state of knowledge, behind the decision at the time it was instituted. Section A2c is more specific to circumstances in your institution. What led them to the decision to put this practice in place? If you find that no one remembers that answer, it is fine to state that there is no institutional knowledge of why the process was initiated. However, you must still give a reasonable answer about why they might have put that procedure in place. Here is an example of the difference between A2b and A2c. Let us assume that your facility uses betadine as a pre-op skin cleanse, but you would like to change to chlorhexidine. A2 is all about why the decision makers chose to use betadine. For A2b you would write about the universal rationale for using betadine when the procedure started. You might state that betadine is a broad spectrum antiseptic with both antibacterial and antifungal properties. Many viruses, protozoa, yeasts, and spores are also susceptible to its antiseptic effect. In a case like this, you would probably want to cite your source for the information about betadine. If your rationale is ‘common knowledge,’ you will not need a citation. A2c, the Explanation section in your rubric, is why the process was started in your institution. Perhaps there were landmark guidelines about pre-operative skin preparation that were issued at the time the decision makers decided to use betadine. There may have been regulatory guidance at the time the process started. The decision may have even been prompted by a series of post-surgical infections within this healthcare system. 3. Recommend a practice change for the process or procedure you selected. Clearly describe the change of practice or process that you are recommending. Support the suggested change with citations from your sources. This should be the first time in the paper that you address the suggested change. You do not have to describe how it would look in your practice setting in A3. You will address that in B3 as you discuss how to implement the change. A3a. List five relevant and credible sources (less than five years old) to support your suggested practice change. Note: Credible sources are less than five years old and may include professional journals, research reports, professional Web sites, governmental reports, current texts less than five years old, and presentations from professional meetings. In this section of your paper you will list your supporting sources that meet the criteria of being five years or less, from recognized credible sources that you are using as evidence about your change. List them here just as you will at the end of the paper: in APA formatted reference citations and in alphabetical order. It may be the same list as you use in the reference page below; however, it may be different. In this section you want only those items that support the change (the new process) that are five years or less. Perhaps you have an older reference that you feel strongly about using in some part of this paper such as the A section. The source that is older than five years can not go in this section. Perhaps you want to include a source in your paper that supports change theory or stakeholders. Sources such as that, which do not directly support the new topic, will go only in the reference page at the bottom of your paper. No information is needed in section A3a other than the list of five or more resources that are five years or less, supporting your new process. 4. Explain the clinical implications your recommended change might have on patients, based on the relevant and credible sources you identified in part A3a. You must use at least 3 of your 5 credible sources from A3a by providing in-text citations to support your statements in this section. Describe the benefit to the patient once the change is implemented. Think about the evidence that this change is a good one for your patients. What are the expected patient outcomes? In this section you will want to pull in data from your five or more resources to support the potential and proven benefits of implementing this change. Remember to think about patient benefit here. 5. Explain the implications your recommended change might have on the practice setting, based on the relevant and credible sources you identified in part A3a. You must use at least 3 of your 5 credible sources from A3a by providing in-text citations to support your statements in this section. This section differs from the one above because it is asking for implications of benefit to the work setting and hospital once you have implemented the new procedure. Remember that costs, infection rates or similar rates, and length of stay are important to facilities. Pull in data from your sources to support the potential and proven benefits that implementing this change will have on the unit or facility. Once again, use your resources from section A3a and use in-text citations to back up your information. Think of the audience that you are trying to influence as you describe the improvements they will see by changing this procedure the way you are suggesting. Information in section 4 and section 5 may overlap at times, as sometimes we do see a benefit to the patient that will also benefit the practice setting. 6. Discuss how you would involve key stakeholders in the decision to change the process or procedure or to comply with the recommended change. Consider what the word stakeholder means and who those people would be throughout this process. Note that this section is not only about the stakeholders (identifying who they are) but it is also about discussing how you will involve them in the decision to change. Students are tempted to talk about how we will tell them about the change. However, that is not what is being asked. Think about change theory here and why we would want to involve them in the decision to change. How can you do that? Think about what you would do to get them to support the change from the beginning of the decision-making process. B. Write an essay in which you do the following: 1. Discuss the specific barriers you may encounter in applying the research to processes and procedures in your practice setting. You should provide 2 barriers to change. 1 barrier can be a physical barrier, change theory, delegation of tasks, time, or money. The other barrier should discuss the barriers to using research: training/education, funding, and staff attitudes toward research. These are areas that impede initiation and continuing compliance with a practice change. Think of the responsibilities of a BSN prepared nurse as a leader of nurses. What if your boss came to you with a topic and asked you to lead a team of three other BSN nurses to research and implement this change by the end of the month. You have to lead them in gathering evidence on the topic—what skills would you expect them to have or what skills would you have to provide/teach/mentor? Where would you expect them to have difficulties when gathering and understanding the research that they want to bring to practice? What would be difficult about taking the words on the pages of your resources and putting them into place in your facility? Please note that we have a full chapter in Houser on this very topic that will help you. Chapter 1 describes the organizational barriers to change and the barriers to implementing evidence based practice. Think of the difficulties of searching, critiquing, understanding, and sharing research that you may have experienced in your own research review. You may also find it helpful to read Houser, Chapter 20: Translating Research into Practice. Also, think back to what you have learned about change theory. There is specific information about barriers to change that can be addressed in this section related to your facility and your chosen change. Notice how similar the barriers to change are to the barriers to using evidence in clinical practice presented in Houser (Chapter 1). Use those barriers to think about your situation and develop your answer. Discuss at least two barriers in this answer. You will be addressing those same two or more barriers in the next question. 2. Identify at least two strategies that you and your team could use to overcome the barriers you discussed in part B1. In this section, continue with your thoughts from above. Explain ways that you can reduce those barriers discussed above. Again, go to change theory (you can research this topic, or use previous course material on change theory) or barriers to using evidence in clinical practice (located in Chapter 1 of Houser) and create a full paragraph about how you can overcome the specific barriers that you discussed in B1. Specific examples related to your facility and change are appropriate. 3. Explain how you would implement your recommended process or procedure based on research findings. You must use all 5 credible sources from A3a by providing in-text citations to support your statements in this section.This is the first time you have been asked in this paper to explain your new change fully. What is it going to look like? Use your five pieces of research to discuss the change and how you are going to implement it. What will be important to do as you implement it and after? Students frequently ask if this section is about what the change is or how to implement it, and my answer is “both.” You want to address the change (what it will look like) and how you will implement it and assess it. Use citations from all of your resources here. C. When you use sources, include all in-text citations and references in APA format. Don’t forget to use in-text citations of all your five pieces of evidence within your paper. This is a class about putting evidence into practice– so use your evidence to back up your statements. Also, don’t forget to include a full reference page even though you put them within the paper in part A3a. Note: For definitions of terms commonly used in the rubric, see the attached Rubric Terms. Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project. Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section. Do not forget to review the rubric criteria.

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