Evidence Based Practice Task 2 (Wgu)
Ruth A
Term paper
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A. Introduction
The author is assigned to an organization where the process of a change-of-shift report is verbal or written presented in individualized and group formats. During reports, one nurse who has previously offered care to the patient transmits information to another nurse having minimum background on the case at hand. Information entailing the condition, treatment prescribed and the plan of care are shared among the nurses in stations. The reports are used for educational purposes as the period of dissemination acquaints the nurses with new medications, equipment or care process. Reports also render an emotional meaning where nurses share with their comrades the various challenges experienced as well as complaints about the patients or their families.
Traditionally, change of shift reports amongst nurses occurs within stations, hallways, conference rooms, and audio tapes, written form as well as telephone services. The ability to include the patient and the family in the exchange of information is significantly affected hence losing care planning. In reference to Griffin (2010), change-of-shift reports ensure transfer of accountability and responsibility of patient care amongst nurses. This kind of communication is characterized by continuity of care and maintaining patient safety.
In my area of practice, most nurses do recognize the importance of bringing the report to the bedside of the patient. However, the implementation of this act is quite uncommon as incorporating patients and families in the process are perceived as a new challenge for nursing staff. Over the periods, change-of-shift reports are carried out at nurse stations, hallways or in a conference room curtailing the contribution of patients and families.
A1. Discussion
.The National Patient Safety Goals need to be incorporated in the change-of-shift report process in this case to enhance the involvement of adult patients in the communication process. The patients and families often seek information. Hence, there is a need to explore their contribution to a bedside report as a patient safety strategy.
The four core concepts of care centered on patients and families include respect and dignity, information sharing, participation as well as collaboration. The overall goal is to use mutually beneficial partnerships to improve the experience of care. In reference to Griffin (2010), change of shift reports provides a unique opportunity through which nurses can partner with patients to improve the healthcare experience.
Regarding respect and dignity, nurses are called upon to honor the perspectives of the patients and family. In this case, care ought to be delivered based on the values, family knowledge, beliefs and cultural background of the patient. Griffin (2010) argues that we should respect patients and families besides viewing them as partners to ascertain that beliefs and morals are valued. In the places of practice, nurses usually do not strive to form partnerships with challenging patients and families hence inadequate care. To ensure safe and satisfying care, nurses can make changes in the process of end of shift reports to incorporate patient and family input. At this stage, patients are informed of the planned care allowing for flexibility as per their request and concerns.
To make decisions on care, the patients are provided with complete and unbiased information with the end of shift reports seen as a crucial timing. During this period, nurses can also obtain a deeper insight of the cultural background and practices that may influence treatment outcomes. Partnering in this case thus ensures that sharing of appropriate information is optimized. In reference to Griffin (2010), patients and families are advised to participate in patient-centered and family-centered care at any level. The adult patients define the persons chosen to get involved in the reporting process. The standard of participation of the patient in the process may vary on a daily basis depending on their emotional and physical state.
As a result, in this scenario, nurses are called upon to be innovative when determining the best report periods to involve patients and families without adversely affecting their schedules. In some cases, patients and families are reluctant to get involved in the reporting process. Griffin (2010) argues that nurses need to define roles hence increasing the comfort of patients and relatives in the process to obtain valuable input. The final concept is collaboration in patient and family centered care that occurs in the development of the policy and the program, implementation, education, evaluation as well as planning. The involvement of patients and families, in this case, ensures that the key points not addressed by the nurses in the report can be amended accordingly.
A2a. Basis for Practice
The visiting hours at my place of practice are restricted to change of shift and implemented by the nurse educators, hospital management, patient experience team and clinical specialists. The practice has widely prevented the inclusion of patients and families in the reports to guarantee patient safety. The principle of the need for confidential patient information to be passed between nurses in stations is to ensure confidentiality, a fundamental ethical concern. The nursing leadership and management in the institution also views verbal reports as vital tools in the routine nursing communication despite the technological advances. Effective communication between nurses is essential in the process of delivering safe care.
The purpose of a report is to communicate the updated information regarding the status, needs, therapy as well as the treatment outcomes of a patient. Verbal reports are in this case considered vital in facilitating clinical decision making and continuity of care. Verbal reports in nursing stations also encourage group cohesion, teaching as well as team-building. Oral handovers are emphasized between all the nurses as the nurse in charge may need to present her comrade with the controlled drug keys where appropriate. The setting occurs in nursing stations where information passed is brief, without any irrelevant details, and discussed within secure rooms away from patients and relatives to uphold confidentiality.
In reference to Griffin (2010), the Institute of Medicine, however, highlights the issue of patient security and the various efforts required to improve care while avoiding errors. Errors are known to occur when the process of communication is affected by gaps in the change-of-shift reporting. The involvement of patients in the care ought to be encouraged as a safety strategy in addition to involving a trusted friend or family if the patient has challenges communicating her condition.
A2b. Rationale
The traditional routine for a change of shift reports includes an exchange of information away from the patients at stations. The current process perceives the health care settings as ones that cannot guarantee privacy hence the need for nurse stations to discourage patients or families from overhearing confidential data. Most of the hospital rooms were not previously built to accommodate patient privacy thus allowing for the use of individual stations.
A2c. Explanation
Change in shift reports is carried out in enclosed channels amongst nurses to avoid the risk of sensitive topics. In this case, Griffin (2010) argues that new information that is previously not shared with the patient and family may arise. These issues are hence in support of the traditional methods of shift report. The stakeholders also considered the impact of alternative methods of dissemination that seemed to decrease nurse efficiency thus affecting patient safety. Traditional verbal handovers without note taking are considered as important when time is a big factor.
An oral report is used in the acute care unit during the change of shift report. There currently lack any procedure or policies that guide the methodology in question. The nursing supervisor describes that the out-going nurse has to brief their co-workers an hour before the end of the shift. The nursing leadership currently has challenges concerning the incompliance of the report model as compared to the regulations presented by The Joint Commission.
A3. Recommendation of Practice Change
In reference to Tan (2015), the process of communication between shift changes is traditionally limited to nurses. A change-shift report should not confine itself to conversation amongst nurses but ought to include the patients who are the recipients of care. As a result, there are enormous challenges when it comes to transforming traditional modes of reporting into bedside reporting that includes patients and families. Tan (2015) indicates that the Patient Centered Care Framework in the health care system calls for changes in the philosophy of nursing.
The communication failures in traditional shift report methods are attributed to the sentinel events within the United States. The Joint Commission Institute (JCI) develops guidelines addressing the concerns hence the need for change in the verbal reports and nurse stations used in the practical setting. As a result, these goals focus on improving accuracy in patient identification, enhance communication effectiveness among caregivers, managing hand-off communications as well as encouraging patient involvement in the care process (Tan, 2015).
There is a need to improve the participation of patient and families in shift reports such as bedside reports to enhance the patient overall safety. Longtin et al. (2010) argue that patients express a desire to select the process of care and management together with the health care providers. As a result, the traditional shift reporting ought to be changed. Laws and Amato (2010) report that regular shift reporting is variable hence posing a risk to the patient safety. In greater detail, conventional methods are repetitive, unstructured in addition to the inconsistency of passing information from one person to the other.
Second, the methods are subjective in content and accompanied by labeling of patients and value judgments by the nurses. In conclusion, the lack of individualized care planning in traditional shift reporting also calls for embracement of bedside reports. By Griffin (2010), bedside reports have greater benefits over regular shift reports as nurses are allowed to introduce their co-worker to the patient. As a result, transparency in information ensures holistic care where patients and family members witness the communication, organization, and professionalism of the health workers.
Patients are hence allowed to contribute to the decision-making process thus improving the treatment outcomes. Giving a report on the bedside of the patient and family enables the nurses to obtain information hence offering an additional resource for accurate diagnosis and treatment. Patient and family participation also facilitates recall of issues and events hence clarifying any errors shared during the report. Bedside reports are essential in incorporating the desires and observation of the patient and family in care.
A3a. List of Sources
Cairns, L., Dudjak, L., Hoffman, R. and Lorenz H. (2013). Utilizing bedside shift report to improve the effectiveness of shift handoff. Journal of Nursing Administration, 43 (3), 160-165.
Freitag, M. and Carroll, V. (2011). Handoff communication: Using failure modes and effects analysis to improve the transition in care process. Quality Management in Health Care, 20(2), 103-109.
Griffin, T. (2010). Bringing Change-of-Shift Report to the Bedside: A Patient- and Family-Centered Approach. Journal of Perinatal and Neonatal Nursing, 24(4), 348-353.
Laws, D. and Amato, S. (2010). Incorporating Bedside Reporting into Change-of –Shift Report. Rehabilitation Nursing, 35(2), 70-74.
Longtin, Y., Sax, H., Leape, L., et al. (2010). Patient Participation: Current Knowledge and Applicability to Patient Safety. Mayo Clinic Proceedings, 85(1), 53-62.
Maxson, P., Derby, K., Wrobleski, D., and Foss, D. (2012). Bedside nurse-to-nurse handoff promotes client safety. MEDSURG Nursing, 21(3), 140-145
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Tan, A. (2015). Emphasizing Caring Components in Nurse-Patient-Nurse Bedside Reporting. International Journal of Caring Sciences, 8(1), 188.
Wakefield, D.S., Ragan, R., Brandt, J., and Tregnago, M. (2012). Coordination of Care: Making the Transition to Nursing Bedside Shift Reports. The Joint Commission Journal on Quality and Patient Safety, 38(6), 243-253.
A4. Clinical Implications
The primary objective of patient and family-centered bedside reports is to enhance sharing of information to assert patient safety and improve care experience. In this case, nurses meet and share vital information in the presence of the patient and family. This kind of handover presents a systemic and safer alternative to preventing common safety issues such as incompatible blood transfusion. In improving the patient satisfaction scores, bedside shift reports are vital by assuring effective communication with the patients (Wakefield et al., 2012).
Bedside shift reports engage the patients and family better hence becoming informed in the decision-making process. In this case, involving patients in the nurse handovers discourages medical errors while improving the outcomes. The ability of patients to ask questions in the presence of nurses alleviates anxiety while boosting satisfaction. The handoffs are viewed as personal, engaging and informative with nurses called upon to maintain equal sensitivity to different patients. As opposed to traditional models of shift report, nurses do not prioritize care before familiarizing with the patient thus accuracy (Laws and Amato, 2010).
A5. Practical Implications
The Institute, in this case, will have to invest in labor as nurses are faced with greater working hours. Bedside reports are the valid answer to medical errors but call for composite measures to engrain effectively in nursing practice. The method supports communication between the hospital staff and nurses about the health of the patient, planned care and progress (Tan, 2015). As a result, the institute in question may improve its ratings regarding safety and efficiency in care provision as the staff is allowed to communicate in a structured manner.
In reference to Freitag and Carroll (2011), a 24-bed unit recorded an increase of 4.4% in the Press-Ganey tool used to measure client satisfaction scores after embracing bedside reports. Besides, reports offered at such a personal level will ensure that patients are involved in care provision to improve treatment outcomes. Also, they provide the organization’s staff with an opportunity to model behavior while sharing their expertise. The availability and access to quality information provide an excellent working environment where nurses are guaranteed support by other staff thus attaining the organizational targets. Shifting to bedside reports will increase the accountability of the nursing staff, better patient satisfaction and safety scores. Upon implementing bedside reports, Freitag and Carroll (2011) reported a 5.5% increase in client perceptions regarding being informed.
When the organization needs to orientate new members of staff and nursing attachés, bedside reports offer an effective platform to help them visualize the real aspects of critical care nursing. In this case, nurses ought to familiarize themselves with the patients before a change in the shift. Maxson et al. (2012) argue that bedside reports allow immediate visualization of the patient thus enhancing prioritization of care. However, the nursing leadership may set a specified period within which a nurse spends with each patient. Upon request for additional information, patients and family may be advised to book an extra session with the involved nurse after the report.
Sand-Jecklin and Sherman (2013) argue that bedside reports significantly impacted responses where patients and their families had to know the nurse assigned to them. It also improves the efficacy and accuracy of shift reports through encouraging experiential learning.
Nurses have expressed their concerns in involving patients and families in shift reports that seems to consume more time while raising concerns about the need for patient confidentiality (Laws and Amato, 2010). The institute ought to carry out training sessions to enhance the need for bedside shift report amongst the nurses. In this case, they should obtain the consent of the patient since some have opted against bedside reports in the presence of their family members.
Nurses are called upon to be conversant with the six-step process followed to perform safety checks and examine any new information. The leadership ought to induce positivity amongst the staff such that they do not possess any prejudice against bedside shift reporting. Cairns et al. (2013) examine the impact of implementing bedside reports amongst nurses where they expressed greater staff accountability. Besides, the proposed change also provided a sense of confidence in the nurses as they provided care.
A6. Stakeholders
Stakeholders include policy makers and the nursing personnel who may, at first, resist the idea of information dissemination in the presence of patients and family. The first step to ensuring that they adhere to the proposed shift, awareness efforts should be made to inform them of the benefits associated with bedside reports. As the current literature is inadequate, the stakeholders are called upon to attend seminars to ensure familiarity and eradicate any prejudice. In the case where nurses assume that bedside reports preclude knowledge of other patients in the unit, the nursing leaders can brief their staff on the state of all patients in the group.
This article has highlighted the issue of patient privacy where bedside reports are seen as an infringement. The stakeholders may thus prepare a consent form for patients and guidelines for nurses to adhere to as they carry out the disclosures. The importance is to inform the patients of the need for bedside reports and the associated benefits towards better healthcare. Nurses have a unique opportunity to design therapy better as they interact with the patient and their families.
To ensure that the recommendations are embraced in the institution to attain long-term objectives, supportive policies need to be presented to accommodate research evidence in routine nursing practice. In reference to Griffin (2010), such information can only be shared amongst the respective nursing staff in the absence of the patients. The primary objective to include the stakeholders is ensuring that they access relevant information on the bedside reporting process. As a result, we can neutralize the negative perception of the model assumed to consume more time while breaching the aspect of confidentiality.
B1. Barriers to Applying Research to Practice
The lack of adequate time to address the recommendations made in research may influence the inability of nurses to use research. In reference to Hewitt-Taylor, Heaslip, and Rowe (2012), nurses are not against using research into clinical practice, but there exist several barriers that inhibit this. An example is the lack of time to deploy the findings in addition to the requirement of more education concerning the use of research. Shifaza, Evans, and Bradley (2014) argue that time constraints inhibit the utilization of inquiry findings where time to read, examine, communicate and implement the evidence is not accommodated. The time to analyze, evaluate and apply research is usually limited to nursing staff hence underlining the inadequate support of the evidence-based practice. A possible solution may for the nursing leadership to provide more time for professional growth and asking their employees to embrace research implementation.
The use of jargon in most studies generates a negative attitude that the investigation is for academics rather than in practical settings. Shifaza, Evans, and Bradley (2014) argue that such individual factors include the lack of comprehensive skills to critique research and the lack of confidence or awareness to implement the recommended changes. The lack of effective communication of the research findings to the staff will often lead to misinterpretation. Institutions may thus increase funds to support the increasing needs for the dissemination of research evidence. The whole process does not end after results are presented to stakeholders since they are entitled with implementation. Overcoming the barrier ensures that nurses and other relevant professionals are called upon to apply research in their areas of practice. In reference to Hewitt-Taylor, Heaslip, and Rowe (2012), they are also requested to review and critique research with an aim of making better decisions in practice rather than for academic use alone.
The other issue is the complexity and the size of research that encourages regular shift reports as opposed to bedside reports. Shifaza, Evans, and Bradley (2014) states that the quality of investigation uses criteria such as inadequate justification of conclusions, methodological inadequacies as well as the presence of conflicting results. In this case, the stakeholders are called upon to deploy services that abstract and synthesize the information. The difficulties involved while developing policies that are evidence based are also significant. Some of the solutions include producing guidelines that outline the process of developing evidence-based guidance in the health care setting. The stakeholders may also use information systems to integrate evidence from research and guidelines in patient care.
The challenge of applying evidence in practice is due to factors such as the inability to access to tests and directives as well as organizational barriers. This case calls for the development of incentives and facilities that support effective care as well as better systems of disease management such as Taskstream. Nursing leaders can improve the effectiveness and quality of research information besides practitioners embracing the improvement programs.
B2. Strategies to Overcome Barriers
In reference to Shifaza, Evans and Bradley (2014) evidence-based practice is a dominant care model aimed at improving health through incorporating research evidence into practice. The best available information is in this case integrated with patient values and the clinical expertise of a nurse to attain better health outcomes as targeted by the organization. Shifaza, Evans, and Bradley (2014) argue that they key strategies to overcome such barriers include encouraging peer and managerial support, availing time for review and implementation of the research findings and seeking the support of fellow workers. Also, the nursing leadership can make supportive policies and offer opportunities to equip the staff with the relevant skills.
Incorporating research findings is a time-consuming process as nurses get confused while determining essential and non-essential elements in the core business of nursing work. Nurses are expected to provide patient care while giving priority to the rising demand for health care and related workloads. Giles et al. (2010) report that the patient care and workload demands have a significant impact on the best intentions of practicing nurses to incorporate research evidence during diagnosis and treatment. Nurses are however called upon to avoid engaging in daily research as it is not a priority compared to the need to assist patients and families.
B3. Implementation of Findings
McMurray et al. (2010) report the importance of Lewin’s theory of planned change that can be used to enhance and facilitate nursing education amongst the staff to embrace acceptance of bedside report in the routine handover. The three steps involved include unfreezing, moving and refreezing that offer a guideline for the activities to be followed by nurse educators in the case study to educate and inform nurses. They ought to have the intention to change perspective, inspire new activities besides establishing a new code of ethics in support of bedside report practice.
In the efficient use of research evidence, clinical policy needs to balance the pros and cons of the study findings with the reality of incorporating the recommendations in practice and clinical settings. The stakeholders are called upon to design models that allow for reviewing and critiquing of research evidence to ensure effective decision making. In the unfreezing phase, the stakeholders are expected to use the research data to support bedside report and the reasoning behind it. In this phase, they also need to indicate the reported outcomes in studies related to the proposed change and inform the staff accordingly (Costello, 2010).
However, the parties involved are expected to exercise patience as the models may sometimes be time-consuming. In reference to Giles et al. (2010), the language deployed in research is an obstacle to effective implementation of findings in practice. To avoid misunderstandings early in the implementation process, members of the team are called upon to understand the flexible research language that varies within several scenarios. Giles et al. (2010) argue that the issue of inadequate funds also affects the implementation of investigation findings.
In this case, accessing resources to support the evidence is sometimes marred by enormous difficulties. Such challenges need to be addressed before progressing into the next stage of implementation besides determining additional factors that may act as restraining forces. The management is hence requested to support research studies in principle to mitigate the risk of incomplete research as a result of poor budgeting. The nursing leaders ought to train nurses for uncertainty as opposed to certainty. In this case, the potential for equipping nurses with decision-making skills ought to be recognized by the relevant stakeholders and implemented. Besides, the nursing staff should be informed of the need to embrace further education and training.
Costello (2010) presents moving as the second stage of Lewin's theory of planned change. In this phase, the process of conducting bedside reports is initiated, and nurses are called upon to manage their time through prioritization in situations where time is limited. For instance, they may opt to read an article or a research review as opposed to reading a clinical journal. Nursing educators are provided with knowledge and skills vital in nurturing the skills of evidence-based decision making. In reference to Giles et al. (2010), the policy makers within the institution should design appropriate state of robust evaluation to accompany the increased teaching of such skills. The organization ought to depict a clear multi-level organizational agenda related to embracing evidence-based nursing. The efforts made to enhance the use of research evidence in decision making should appreciate the roles played by other stakeholders in the institution such as patients and physicians.
In the final phase, Kassen and Jagoo (2005) argue that refreezing entails the stage where bedside reporting has finally been embraced as the exclusive handover process. The healthcare management at the local and federal level are asked to combat occupational cultures where questioning or acknowledgment of uncertainty is widely discouraged amongst the nursing staff. At this stage, the hospital management will have budgeted adequately for the model as bringing research evidence into practice calls for the introduction of information technology closer the nursing work environment. Nursing leaders are asked to provide validated methods of teaching and support with emphasis on health service librarians who are vital information brokers.
References
Costello M. (2010). Changing handoffs: The shift is on. Nursing Management, 41 (10), 39-42.
Giles, M., Guest, E., Keating, D., Kepreotes, E., and Winkskill, R. (2010). Doing clinical research: The challenges and benefits. eContent Management Scholarly Research for the Professions. Retrieved from: http://pubs.e-contentmanagement.com/doi/abs/10.5172/conu.2010.35.2.171?journalCode=conu.
Hewitt-Taylor, J., Heaslip, V., and Rowe, N.E. (2012). Applying research to practice: exploring the barriers. Br J Nurs, 21(6), 356-359.
Kassean, H., and Jagoo, Z. (2005). Managing change in the nursing handover from traditional to bedside handover-A case study from Mauritius. BioMed Central Nursing, 4 (1), 1-6. Doi: 10.1186/1472-6955-4-1
McMurray, A., Chaboyer, W., Wallis, M, and Fetherston, C. (2010). Implementing bedside handover: Strategies for change management. Journal of Clinical Nursing, 19, 2580-2589.
Shifaza, F., Evans, D., and Bradley, H. (2014). Nurses’ Perceptions of Barriers and Facilitators to Implement EBP in the Maldives. Advances in Nursing, 2014(698604), 7. doi:10.1155/2014/698604.
