You are to create an 8- to 9-slide PowerPoint presentation in which you do the following:Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.) Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general. Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered. Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation. Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change. Be sure to provide APA citations of the supporting evidence-based peer-reviewed articles you selected to support your thinking. Add a lessons learned section that includes the following: A summary of the critical appraisal of the peer-reviewed articles you previously submitted An explanation about what you learned from completing the evaluation table (1 slide) An explanation about what you learned from completing the levels of evidence table (1 slide) An explanation about what you learned from completing the outcomes synthesis table (1 slide) Here are some helpful hints for your Powerpoint projects due this week.1. Do not make the slides too wordy. Use Bullet points2. Use Speaker Notes if needed for additional information3. Select your slide design carefully and make sure information fits on the slide and does not overhang4. Avoid white font unless on dark background5. Do not forget a Title slide with the same information as a Title page6. Be creative
You are to create an 8- to 9-slide PowerPoint presentation in which you do the following: Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to
CRITICAL APPRAISAL OF RESEARCH 4B: Critical Appraisal of Research Lakme O’Connell Walden University Essentials of Evidence Based Practice NURS-6052N 7/17/20 4B: Critical Appraisal of Research The best practice arising from the four research articles’ critical appraisal was the article discussing the impacts of a work shift to quality of care in nursing practice (Lin, 2014). This is because a prolonged work schedule of nurses is a common thing, very little is recognized regarding how such extended hours influence the care patients to get or the nurses’ well-being (Stimpfel, 2013). Even though there are schedules for nurses, the tangible shifts are unpredictable due to fluxes in patient wants and unexpected staffing modifications. Because of this, nurses are forced to work overtime past the scheduled length of shift. Once long shifts are merged with overtime, shifts, which revolve between day and night responsibility, and the following shifts, nurses face the risk of stress and exhaustion, which as a result, may compromise the patients’ care (Stimpfel, 2012). Regardless of the guidelines on the length of shifts and the collective working hours for resident doctors and other people in other organizations, national work hour guidelines for registered nurses are lacking. Nurses have always reported being coerced about working overtime. Following the fact that nurses are facing a lot of challenges regarding the prolonged shifts, it is a significant area of study that aims to improve patient care and because there is limited research regarding this area of study. Therefore, it is vital to study the impacts the working shifts have on the work outcome of nurses and patient care. References Lin, S. H., Liao, W. C., Chen, M. Y., & Fan, J. Y. (2014). The impact of shift work on nurses’ Job stress, sleep quality, and self‐perceived health status. Journal of nursing management, 22(5), 604-612. Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, The higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509. Stimpfel, A. W., & Aiken, L. H. (2013). Hospital staff nurses’ shift length associated with safety And the quality of care. Journal of Nursing Care Quality, 28(2), 122. References Lin, S. H., Liao, W. C., Chen, M. Y., & Fan, J. Y. (2014). The impact of shift work on nurses’ Job stress, sleep quality, and self‐perceived health status. Journal of nursing management, 22(5), 604-612. Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, The higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509. Stimpfel, A. W., & Aiken, L. H. (2013). Hospital staff nurses’ shift length associated with safety And the quality of care. Journal of Nursing Care Quality, 28(2), 122.
You are to create an 8- to 9-slide PowerPoint presentation in which you do the following: Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to
Running head: CRITICAL APPRASAL 0 Critical Appraisal Lakme O’Connell Walden University Essentials of Evidence Based Practice NURS-6052 7/6/20 Critical Appraisal Based on my review, the best practice that I chose was the study conducted by (Delgado, 2020) on managing patients in critical care. The research study is relevant for my nursing practice and therefore useful in promoting nursing care in critical patients such as those in intensive care units. Critically ill patients undergo excruciating pain due to medical procedures and the underlying disease processes. Through analgesics have widely been used to manage such patients, several limitations have been encountered. Nurses have not been able to balance patient comfort by use of analgesics and the complications linked with analgesic treatment. By evaluating sources of discomfort in the patient and adjusting the pain techniques for alleviating pain in such patients, nurses can ensure that the risks of complications due to the analgesics are minimized. In 2018, guidelines were established for patients in the management of Pain, Agitation, Delirium, Immobility and Sleep, commonly called PADIS (Devlin et al., 2018). This was a slight deviation from the original document in 2013 cited PAD (Barr et al., 2013). Although the 2018 document addresses a wider perspective including immobility and sleep, both guidelines are based on research as well as expert opinion. A more detailed analysis by Barnes-Daly et al., (2017) highlighted that compliance to the choice of drugs, among other mechanisms commonly stated as ABCDEF resulted to improved clinical outcomes of patients in critical care. The bundle was implemented across seven community hospitals. An interpersonal team model was applied to the patients in the hospital’s ICUs to operationalize the PADIS guidelines. The bundle was further expanded to incorporate other aspects, such as prevention of pain, assessing and managing delirium, early mobility, and the choice of sedation (Marra, Ely, Pandharipande, & Patel, 2017). References Barnes-Daly, M., Phillips, G., & Ely, E. (2017). Improving Hospital Survival and Reducing Brain Dysfunction at Seven California Community Hospitals. Critical Care Medicine, 45(2), 171-178. doi: 10.1097/ccm.0000000000002149 Barr, J., Fraser, G., Puntillo, K., Ely, E., Gélinas, C., & Dasta, J. et al. (2013). Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit. Critical Care Medicine, 41(1), 263-306. doi: 10.1097/ccm.0b013e3182783b72 Delgado, S. A. (2020). CE: Managing Pain in Critically Ill Adults: A Holistic Approach. AJN, American Journal of Nursing, 120(5), 34-42. doi: 10.1097/01.naj.0000662808.81949.d6 Devlin, J., Skrobik, Y., Gélinas, C., Needham, D., Slooter, A., & Pandharipande, P. et al. (2018). Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Critical Care Medicine, 46(9), e825-e873. doi: 10.1097/ccm.0000000000003299 Marra, A., Ely, E. W., Pandharipande, P. P., & Patel, M. B. (2017). The ABCDEF Bundle in Critical Care. Critical Care Clinics, 33(2), 225-243. doi:10.1016/j.ccc.2016.12.005
You are to create an 8- to 9-slide PowerPoint presentation in which you do the following: Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to
Critical Appraisal Tool Worksheet Template Evaluation Table Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research. Full APA formatted citation of selected articles. Article #1 Article #2 Article #3 Article #4 Lin, S. H., Liao, W. C., Chen, M. Y., & Fan, J. Y. (2014). The impact of shift work on nurses’ job stress, sleep quality, and self‐perceived health status. Journal of nursing management, 22(5), 604-612. Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer Schiffer, C. A., Mangu, P. B., Wade, J. C., Camp-Sorrell, D., Cope, D. G., El-Rayes, B. F., … & Levine, M. (2013). Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol, 31(10), 1357-1370. Ghadmgahi, F., Zighaimat, F., Ebadi, A., & Houshmand, A. (2011). Knowledge, attitude, and self-efficacy of nursing staff in hospital infection control. Journal Mil Med, 13(3), 167-172. Evidence Level * (I, II, or III) III III Conceptual Framework Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here). ** None is mentioned Educational intervention programs for parents of infants born prematurely instigated early in the Neonatal Intensive Care Unit can cut parental stress, depression, and anxiety, improve parent-infant relations, and decrease the length of stay in hospital. None mentioned. None mentioned Design/Method Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). A cross-sectional study that included 266 nurses from four Chiayi county district hospitals. Data was collected using a demographics, stress checklist, work schedule forms, a health status measure, and sleep-quality measure. The collected data were analyzed using Pearson’s r, one way ANOVA, Independent t-test, and hierarchical regression. A randomized control trial study. Study subjects were randomly assigned to receive Creating Opportunities for Parental Empowerment or a comparison intervention program. A systematic search of MEDLINE and the Cochrane library. All articles with evidence-based guidelines on central venous catheters for patients with cancer were included, while those lacking this information excluded. Cross-sectional study, including 135 study subjects. Sample/Setting The number and characteristics of patients, attrition rate, etc. Two hundred and sixty-six nurses working in Taiwan. There was no attrition of the study participants. Two hundred and sixty families with preterm infants. 61preterm infants were transferred to another hospital. Five articles with evidence-based guideline questions. 135 nurses working in selected Mashhad hospitals Major Variables Studied List and define dependent and independent variables. Dependent variables- sleep quality, nurses’ stress, and self-perceived health status. Independent variables were the nurses’ ages and gender. State anxiety, depressive symptoms, stress related to the NICU, quality of parent-infant interaction in the NICU. Independent variables-parental beliefs. Dependent-Catheter type, insertion site, and placement. Independent-age, sex Dependent-Nosocomial infections control, knowledge, attitude, and self-efficacy. Independent- Age, sex of nurses. Measurement Identify primary statistics used to answer clinical questions (You need to list the actual tests done). Independent t-test, one-way ANOVA, hierarchical regression, Pearson’s r Parental stressor scale Index of parental behavior-NICU Parental beliefs scale. Randomized controlled tests with results specific to cancer patients Man-Whitney tests, Chi-square tests. Data Analysis Statistical or Qualitative findings (You need to enter the actual numbers determined by the statistical tests or qualitative data). 266 nurses reported moderate job stress, poor sleep quality, and average self-perceived health status. Stress-related to NICU-.94-.96. Quality of parent-infant interaction in NICU-.83-.86. Parental beliefs- .90-.93. None 67.9% nurses have common knowledge, 29.9% had good understanding, and 90.4% had positive attitude, 25.2% average self-efficacy, and 74.8% functional self-efficacy. Findings and Recommendations General findings and recommendations of the research The nurses displayed moderate job stress, poor quality of sleep, and sensible self-perceived health regardless of the amount of shift work they did. Hospital managers should make sure more healthy work shifts scheduling to improve clinical performance and individual health status of nurses to improve the quality of care. A reproducible theory-based intervention with parents of preterm babies in NICU results in less parental stress, more positive familial interactions in the NICU, less anxiety, and depressive symptoms after hospitalization and a decreased LOS for preterm. It is essential to encourage mothers with preterm infants to embrace NICU. Femoral catheterization should be avoided, well-trained providers should place CVC. A clinical care CVC bundle to be used. Heparin-impregnated and antimicrobial-impregnated CVCs to be used. No significant relationship between knowledge and self-efficacy. No correlation between attitude and efficacy. Significant relation between knowledge and sex. Recommendations- training of nurses to increase their knowledge and attitude. Appraisal and Study Quality Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice? The article is essential in providing an insight into the significance of work shifts in healthcare facilities. Strengths- the methods and design of study were useful. No limitations. The research is worth practicing by nurses to improve the health of parents with preterm infants. Strengths-the study methods and design were appropriate. Limitations-infants transferred before the end of the study period. The quality of the study is sound. However, the literature had a small number of patients with heterogeneity in trial design, types of catheter, placement techniques, and evaluation methods. Also, there were changes in clinical practices. The study is worth because the information therein is an eye-opener to nursing professionals regarding nosocomial infections. Strengths-the study design and methods were appropriate. Limitations- un-answered questionnaires. Key findings Job stress inversely related to sleep quality, sleep quality directly related to self-perceived health status. Parental beliefs and roles significantly correlated with a shorter NICU length of stay. Less maternal depression, less stress, and anxiety in the NICU. Mothers and fathers in COPE program recorded positive interactions with their infants. The overall quality of evidence regarding catheter use in cancer patients was good. Nurses lack appropriate knowledge regarding control of nosocomial infections. Outcomes Moderate job stress, poor sleep quality, and average self-perceived health status. Infants’ shorter days of stay in NICU. The evidence-based guideline on central venous catheters for cancer patients was established. Nurses lack appropriate knowledge regarding nosocomial infections. General Notes/Comments Giving healthcare workers shift at work is critical for their productivity and health. The article was full of relevant information. The article gave precise information concerning catheter use on cancer patients, a crucial area of study. Knowledge regarding nosocomial infections is fundamental, and the article explains precisely why nurses should acquire this knowledge. *These levels are from the Johns Hopkins Nursing Evidence-Based Practice: Evidence Level and Quality Guide Level I Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis Level II Quasi-experimental studies, a systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis Level III Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, a qualitative, qualitative systematic review with/without meta-synthesis. Level IV Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence Level V Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence **Note on Conceptual Framework The following information is from Walden’s academic guides, which helps explain conceptual frameworks and the reasons they are used in research. Here is the link https://academicguides.waldenu.edu/library/conceptualframework Researchers create theoretical and conceptual frameworks that include a philosophical and methodological model to help design their work. A formal theory provides context for the outcome of the events conducted in the research. The data collection and analysis are also based on the theoretical and conceptual framework. As stated by Grant and Osanloo (2014), “Without a theoretical framework, the structure and vision for a study are unclear, much like a house that cannot be constructed without a blueprint. By contrast, a research plan that contains a theoretical framework allows the dissertation study to be strong and structured with an organized flow from one chapter to the next.” Theoretical and conceptual frameworks provide evidence of academic standards and procedures. They also explain why the study is pertinent and how the researcher expects to fill the literature gap. Literature does not always clearly delineate between a theoretical or conceptual framework. With that being said, there are slight differences between the two. References The Johns Hopkins Hospital/Johns Hopkins University (n.d.). Johns Hopkins nursing evidence-based practice: appendix C: evidence level and quality guide. Retrieved October 23, 2019, from https://www.hopkinsmedicine.org/evidence-based-practice/_docs/appendix_c_evidence_level_quality_guide.pdf Chapter 5, “Critically Appraising Quantitative Evidence for Clinical Decision Making” (pp. 124–188) Chapter 6, “Critically Appraising Qualitative Evidence for Clinical Decision Making” (pp. 189–218) Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010a). Evidence-based practice step by step: Critical appraisal of the evidence: Part I. American Journal of Nursing, 110(7), 47–52. doi:10.1097/01.NAJ.0000383935.22721.9c Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010b). Evidence-based practice, step by step: Critical appraisal of the evidence: Part II: Digging deeper—examining the “keeper” studies. American Journal of Nursing, 110(9), 41–48. doi:10.1097/01.NAJ.0000388264.49427.f9 Fineout-Overholt, E., Melnyk, B. M., Stillwell, S. B., & Williamson, K. M. (2010c). Evidence-based practice, step by step: Critical appraisal of the evidence: Part III: The process of synthesis: Seeing similarities and differences across the body of evidence. American Journal of Nursing, 110(11), 43–51. doi: 10.1097/01.NAJ.0000390523.99066.b5 Grant, C., & Osanloo, A. (2014). Understanding, Selecting, and Integrating a Theoretical Framework in Dissertation Research: Creating the Blueprint for Your” House.” Administrative Issues Journal: Education, Practice, and Research, 4(2), 12-26. Laureate Education (Producer). (2018). Interpreting Statistics [Video file]. Baltimore, MD: Author. Laureate Education (Producer). (2018). Review of research: Hierarchy of evidence pyramid [Mutlimedia file]. Baltimore, MD: Author. Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer. Schulich Library McGill. (2017, June 6). Types of reviews [Video file]. Retrieved from https://youtu.be/5Rv9z7Mp4kg Walden University Academic Guides (n.d.). Conceptual & theoretical frameworks overview. Retrieved October 23, 2019, from https://academicguides.waldenu.edu/library/conceptualframework Williamson, K. M. (2009). Evidence-based practice: Critical appraisal of qualitative evidence. Journal of the American Psychiatric Nurses Association, 15(3), 202–207. doi:10.1177/1078390309338733 © 2018 Laureate Education Inc. 10
You are to create an 8- to 9-slide PowerPoint presentation in which you do the following: Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to
Brief assessment of the Results of Work Environment Assessment Based on the results, how civil is your workplace? Based on the results, my score was 60, workplace is mildly Healthy. This indicates that my workplace is not a very civil environment. Explain why your workplace is or is not civil? My workplace is not civil because of lack of proper and respectful communications among employees and employers. Most of the leadership are disrespectful towards each other and this really affects the workplace environment, and therefore interferes with employee’s morale, which in turn affects patient care. Very poor communications are also seen between the employers and their employees. (Smith et al.,1994) Another reason that makes me feel that my workplace is not civil is heavy workload on the employees. The employees are assigned a lot of tasks to do which they can’t really be manage in a timely manner and hence more nurses should be employed to reduce the workload to provide more efficient patient care. (Forstater et al., 2004) Describe a situation you have experienced incivility in the workplace. A situation where I experienced incivility in my workplace was being denied a chance of being promoted after advancement. I went for my advancement studies and pursued a bachelor’s degree. Before leaving for my studies, I was promised to be promoted to a leadership role which I was denied after completing my bachelor’s Degree, not due to merit, or my work ethic. I was overlooked because of the friendship between the director of nursing and perspective assistant director of nursing, and therefore the job was given to the friend. (Lawn et al., 2004) How was this addressed? This incivility was addressed by leadership being transferred to another organization after a series of disagreements with the employers. References Forstater, M. (2004). Green jobs: addressing the critical issues surrounding the environment, workplace, and employment. International Journal Of Environment, Workplace And Employment, 1(1), 53. doi: 10.1504/ijewe.2004.005603 Lawn, P. (2004). Environment, workplace, and employment: an introduction. International Journal Of Environment, Workplace And Employment, 1(1), 4. doi: 10.1504/ijewe.2004.005601 Smith, E. (1994). WORKPLACE ASSESSMENT. The Annals Of Occupational Hygiene. doi: 10.1093/annhyg/38.1.1
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