Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”
Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.
Response posts: Minimum 100 words excluding references.
Peer 1:
In this discussion post I will be talking about the steps of evidence-based practice (EBP), how to get started with an inquiry, and facilitators and barriers to evidence-based practice as it pertains to a rural, critical access ED. EBP is a way of raising a question related to patients and using the best and most recent evidence, assessment, and inclusion of patient values to support or negate the question at hand (Goodshall, 2020). EBP is important because nurses need guidance that has proof behind it to lead them in the way they practice, not just rely on blind trust or the word of a co-worker in their performance.
The important clinical question when looking at the rural ED with patients who don’t complete follow up care is, why aren’t they following through with what the doctor is advising? The first step to figuring out this answer would be to refer to hospital policies or already known information on the subject. When that information is gathered, it should be combined with information that is found and is factual and relevant to the issue from peer reviewed and academic sources. This, combined with knowledge a nurse already has, can help create a suggestion for change. If the change is allowed to be implemented, the results should be shared with other colleagues about how it affected care.
Before undertaking this project, a nurse could create a survey for patients to see why they are not participating in follow-up care or speak with local agencies about what they think is causing the issue. They would want to know things like patient literacy of healthcare systems, patterns of types of cases seen in the ED, types of insurance or coverage a patient has, or reasons patients opt to come to the ED to start with. For example, long wait times for a doctor or being denied services at an outpatient facility due to lack of insurance may be a contributing factor.
Some of the people who may be involved in the development of this project could be hospital boards or administration, co-workers who help carry out the research, the community with any input they may have, anyone doing credible research related to this project, and the patients. In involving these different facets, some of the barriers that could be encountered would be not enough time to carry out the research, adding more work to already overworked healthcare professionals, resistance to change and adherence to outdated ways compared to facilitators like leadership who helps facilitate the change and creating a space and time for nurses to be educated on the problem at hand. (Rumage & Foran, 2023).
In conclusion, implementing an evidence-based practice change in a rural ED that is seeing outpatient patient problems regularly would need to go through the full seven steps to become successful in the transition. If nurses feel they are seeing a practice that is outdated or possibly dangerous to the patients they serve they should start the process of developing a change to better the situation and do their due diligence of researching the subject. Nurses are on the frontline of patient care and have the ability to make changes that can improve outcomes for patients and better working conditions for nurses.
References
Godshall, M. (2020). Fast facts for evidence-based practice in nursing (3rd ed.). Springer Publishing Company.
Ramage, B., & Foran, P. (2023). Evidence-based practice in perioperative nursing: Barriers and facilitators to compliance. Journal of Perioperative Nursing, 36(2), 37-41. https://doi.org/10.26550/2209-1092.1265
Peer 2:
The purpose of this discussion posting is to discuss how to ignite a spirit of inquiry within a rural emergency department to develop an EBP to reduce the utilization of the emergency room as primary care, reducing the wait time of the patient and improving the overall health of the patient stakeholder. Also, discussed will be the identification of stakeholders and pertinent information to be considered before planning such project.
According to Melnyk (2009), a way to spark inquiry is to ask “why?”. In this instance asking “why does our emergency room resemble a primary care practice” or “why are we seeing so many non emergency patients” would be placed on a poster and placed in a space where nurses congregate along with a materials to be able for them to provide answers to the question. After a sufficient time has passed to allow for answers to be generated the ideas shared would be arranged by commonalities and presented for discussion during a staff meeting. (Melnyk, 2009)
The stake holders for this study would include the patients themselves, the nursing staff, the local primary care providers, the hospital system, applicable insurance companies, as well as, the local department of health, local schools and potential transportation services.
Prior to planning a project, it is essential to determine what is important to the stakeholders. Studies have shown that patients hold different beliefs regarding health care based on the patients, socioeconomic status, race, and education. (Hirpa, 2020) By asking patients what is important to them the faux pas of assumption can be avoided. After identifying what is important to patients, then the availability of resources to implement changes based upon their preferences must be identified. In this instance accessibility, availability and approachability of primary care providers would have to be recognized. If the local emergency room is the closest facility for medical care or a patient is uncomfortable seeing the only practitioner within in walking distance and no other means of transportation is available, that level of care would not take place without further intervention. Thus, it is important to recognize available transportation services and how payment for such services would be facilitated.
As insurance companies including Medicare/Medicaid are transitioning to paying for services taking patient satisfaction into account and getting away from paying based upon a fee for service template (Hirpa, 2020) the hospital being able to reduce wait times and improve patient satisfaction is important.
It is common knowledge that nurse burnout is on the rise. By reducing the work overload created by the number of patients relying on the emergency room as a primary care provider, potential nurse burnout could be reduced over time.
As poverty, unemployment and drug use are usually associated with lower education levels, involving the local schools and health department education can be provided to citizens on what conditions are appropriate for an emergency room and the importance of having a primary care physician.
In general evidence based practice (EBP) is facilitated when nurse have an understanding of the importance of the methodology and are working within an organization that promotes utilizing EBP as their standard of care as well as supporting the continuing education of the nursing staff. Nurses who lack EBP mentorship, or proper resources or the time to research, hinders a facilities ability to provide EBP care. (Melnyk, 2009)
In summary asking “why” builds a spirit of inquiry, identifying stake holders and asking what is important to each, can help to build an EBP that can improve the health of patients, reduce the number of patients utilizing the emergency room as their primary care and potentially reduce the burnout of nursing working in that emergency room.
Melnyk, B. M., Fineout‐Overholt, E., Stillwell, S. B., & Williamson, K. (2009). Evidence-Based Practice: Step by Step: Igniting a Spirit of Inquiry. The American Journal of Nursing/American Journal of Nursing, 109(11), 49–52. https://doi.org/10.1097/01.naj.0000363354.53883.58
Hirpa M, Woreta T, Addis H, Kebede S (2020) What matters to patients? A timely question for value-based care. PLOS ONE 15(7): e0227845. https://doi.org/10.1371/journal.pone.0227845
