The organization and individuals engaged in scientific investigation using methods and variables that influence the rate and extent of adoption of practices to improve clinical services is known as:
- translation research.
- evidence-based practice.
- research utilization.
- best practice.
The correct answer is translation research or implementation science, where the organization and individuals invest in scientific investigation using methods and variables to determine the influence rate and extent of adoption of evidence-based practices to improve clinical services. Evidence-based practice involves steps to integrate research and other best evidence with clinical expertise and client values in daily health care decision making. Research utilization is a process of using research findings as a basis for practice. Best practice is applying the most recent, relevant nursing interventions in clinical practice which describe innovative practices that are recognized by peer organizations and contribute to meeting quality or fiscal goals.
A strategy of demonstrating an opportunity for improvement at baseline, outlining current practice related to specific care process indicators is:
- outreach or academic detailing.
- change champions.
- performance gap assessment.
- audit and feedback.
performance gap assessment
Performance gap assessment is a strategy of demonstrating an opportunity for improvement at baseline, outlining current practice related to specific care process indicators. Outreach or academic detailing is a marketing strategy in which a trained individual meets one on one with practitioners in their setting to provide information about the evidence-based algorithms, work flows, or practices and indicators to improve practice. Change champions are practitioners from the local peer group who continually promote the practice change by using new technologies, interventions, and work flows that include evidence-based practices. Audit and feedback is the ongoing monitoring of critical indicators of practice and providing periodic reporting of data and information back to the clinicians responsible for client care.
A rigorous scientific process used to combine findings from research into a powerful and clinically useful report to guide practice is:
- performance appraisal.
- practice guideline.
- implementation science.
- systematic review.
Systematic review is a rigorous scientific process used to combine findings from research into a powerful and clinically useful report to guide practice. The IOM describes the processes of the systematic reviews and initiating a search, finding and assessing the studies, synthesizing the body of evidence and reporting using a standard format. Performance appraisal is an evaluation process based on job descriptions, with inclusion of evidence-based practice components across to promote positive reinforcement and expectations in the work environment. A practice guideline is a statement designed to assist the provider and client in making decisions about appropriate health care for specific clinical circumstances. Implementation science is a type of scientific investigation that supports movement of evidence-based, effective health care approaches from clinical knowledge into routine use, testing strategies to promote uptake, and use of innovations such as building the database of knowledge into the electronic health record, redesign of a clinical work flow, or electronic forms associated with patient care technologies.
Leadership is necessary across all organizational levels, and different roles can support implementing evidence-based changes. Which of the following roles are important to the success of this transformation of practice? (Select all that apply.)
- Senior leaders
- Medical staff directors
- Chief nurse executives
- Opinion leaders
- Project director
- Chief nurse executives Correct
- Opinion leaders
There are many roles, such as the chief nurse executive through nurse managers, advanced practice registered nurses, and staff nurses. Everyone in evidence-based practice work has a role that builds upon their knowledge and skills. Nurse executives have organizational responsibility for creating a culture in which clinicians expect evidence-based practice, and they have the capacity to develop and sustain a vision inclusive of evidence-based practice. Opinion leaders are informal leaders from the local health care setting who are viewed as important and respected sources of influence by those in their peer group. The opinion leaders could be advanced practice registered nurses who can function as facilitators or staff nurses who are expert clinicians who have the skills to collaborate, problem solve, and find creative solutions. Other key individuals would be nurse managers who use participatory leadership to promote and create action plans to support evidence-based practice, set the expectations for the unit, discuss the importance of the work of evidence-based practice with the unit nurses and other disciplines, encourage and respond to new ideas, promote staff questioning practice, support the team with time to work on the project, act as project cheerleaders, track progress, facilitate moving the project through appropriate committees, and allocate resources as needed. Senior leaders may not be important but they are an involved group because they manage the resources and share the quality and financial reports with board and other entities to promote the investment of resources to achieve further benefits from evidence-based practices. The medical staff directors may not be important to the change but should be informed of what is happening, similar to the senior leaders, to be supporting agents. Project directors which are likely nurses who have the ability to take on the most challenging steps in the evidence-based practice process by leading the team, critiquing and synthesizing the evidence, developing and evaluation plan, identifying roadblocks, facilitating problem solving during implementation, analyzing and reporting results and providing expertise in the clinical work flow.
Which of the following are the building blocks that nurses should use to develop the organizational structures to support an evidence-based practice environment? (Select all that apply.)
a. Incorporate evidence-based practice terminology into mission, vision, strategic plan, and performance appraisals.
b. Establish explicit expectations about evidence-based practice for nursing leaders with a culture that values clinical inquiry.
c. Demonstrate the value of evidence-based practice through administrative behaviors of the chief nurse executive.
d. Educate nurse executives, nurse managers, nurses, physicians, and other health care professionals about the value of evidence-based practices.
e. Integrate evidence-based practice into the governance structure of nursing departments and the health care system.
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