Please if you could reply to the following 3 DQ with 150-200 words. Thank you 

Isabel:

This week’s readings provided an informative antecedent to the identified need for enhancement of patient safety, and the development of evidence-based practice (EBP) with the publication of the National Academy of Medicines (NAM) groundbreaking report, To Err is Human: Building a Safer Health System (Kohn, Corrigan, & Donaldson, 2000 as cited in Boehm, Stolldorf, & Jeffery, 2020). The report identified six dimensions for healthcare improvement, which included the focus for implementation of EBP, reducing preventable harm in healthcare, and continue to drive quality improvement (QI) initiatives. These are important factors to remember when starting a project to improve patient outcomes. 

When the implementation process is in full swing, factors to address include obstacles and barriers that can impede the process. Mathieson, Grande, & Luker (2019) reported some obstacles and barriers that included lack of time, staff shortage, heavy patient caseload, family commitments, limited knowledge of EBP and negative beliefs toward it, and limited academic skills (Brooke & Mallion, 2016). Mathieson et al. (2019) further state that many publications fail to address why and how implementation processes have worked or why attempts failed, which is a barrier in itself. 

One barrier that I believe could be my project’s biggest obstacle would be staffing and standing priorities. Due to the current climate of a pandemic, priorities are focused on maintaining a stronghold on COVID-19. This includes pooling all available staff to the floors experiencing surges of patients. Financing and available staff to fill the nurse-led education programs could be my biggest obstacle for my intended project. 

References

Boehm, L. M., Stolldorf, D. P., & Jeffery, A. D. (2020). Implementation Science Training and Resources for Nurses and Nurse Scientists. Journal of Nursing Scholarship; Indianapolis, 52(1), 47-54. DOI:https://10.1111/jnu.12510

Brooke, J. M., & Mallion, J. (2016). Implementation of evidence-based practice by nurses working in community settings and their strategies to mentor student nurses to develop evidence-based practice: A qualitative study. International Journal of Nursing Practice, 22(4), 339-347. doi:https://doi.org/10.1111/ijn.12470

Kohn, L. T., Corrigan, J. M., & & Donaldson, M. S. (2000). To Err is Human: Building a Safer Health System. Institute of Medicine (US) Committee on Quality of Health Care in America. National Academies Press (US). DOI:https://10.17226/9728

Mathieson, A., Grande, G., & Luker, K. (2019). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development; Cambridge, 20. DOI:https://10.1017/S1463423618000488

Merriam-Webster. (n.d.). Antecedent. Retrieved from In Merriam-Webster.com dictionary: https://www.merriam-webster.com/dictionary/anteced…

Mini:

Evidence-based practice or EBP in nursing is a combination of clinical expertise mixed in with research evidence while taking the patients preferences into consideration. By integrating evidence-based practice into nursing opens up problem-solving solutions and thus encourages nurses to provide better care to their patients in respect to their needs. “Clinical judgment is at the centre of provision of healthcare. It is a critical aspect of EBP which is used to health nurses and other healthcare practitioners to make the best appropriate clinical decision that will result to least health effect on the patient. EBP decision making process need to be based on rational technical knowledge , best identified and research practice , and patient contribution” ( All Answers Ltd,2018). In nursing there are many barriers and obstacles that obstruct the implementation of evidence-based practice in nursing, some examples of this would be inadequate support from nurse leaders and managers, inadequate of resources and investments in EBP, insufficient EBP knowledge and skills of nurse, misperception that EBP needs excessive time and organisational culture and policies. One of the major obstacles is that EBP’s need excessive time to implement, inadequate of time is often the main reason why implementing EBP has been overlooked in many instances and in addition to that uncertainty or not knowing about EBP process is also contributing to the obstruction of this process. 

Reference:

All Answers Ltd. (November 2018). Challenges Of Implementing Evidence Based Practice Nursing Essay. Retrieved from https://nursinganswers.net/essays/challenges-of-im…

Michelle:

Evidence-based practice (EBP) is the foundation of quality patient care. It improves the nursing practice and increases the confidence in decision-making. EBP is used to solve clinical issues in patient care by integrating well-designed evidence with patient preferences, patient assessments, and health professionals (Alatawi, et. al., 2020). Five organizational barriers to implementing EBP were lack of support and supervision, heavy workload, lack of training and education, limited resources, and time restrictions (Khammarnia, et. al., 2015). There are also four main themes considered as an individual barrier to implementing EBP: lack of nurses’ knowledge, skills and awareness regarding EBP, lack of professional characteristic, nurses’ attitude and experience in using, and language barrier in using or implementing EBP. 

Two of the obstacles observed at Salt River Community Health Clinic (SRCHC) is heavy workload and time restrictions. It is during the Covid-19 pandemic that the employees of SRCHC are challenged with their daily work functions on top of facing problems during the pandemic such as a heavy influx of patients coming in for testing, vaccinations, and sickness. There is a heavy employee turnover rate because of the heavy workload faced by employees, and it causes friction within the company. It makes it difficult for acceptance of change within the organization when pandemic issues are the priority currently. For future practice, SRCHC nurse administrators and educators have a main role to simplify EBP among nurses and the employees. Time management, providing the required resources and adequate supervision can facilitate the implementation of EBP which positively influences the quality of care (Alatawi, et. al., 2020). There will need to be enough time allotted in the initial stages of the change implementation to overcome these challenges. 

References

Alatawi, M., Aljuhani, E., Alsufiany, F., Aleid, K., Rawah, R., Aljanabi, S., & Banakhar, M. (2020). Barriers of implementing evidence-based practice in nursing profession: A literature review. American Journal of Nursing Science, 9(1), 35-42. 

Khammarnia, M., Haj Mohammadi, M., Amani, Z., Rezaeian, S., & Setoodehzadeh, F. (2015). Barriers to implementation of evidence-based practice in zahedan teaching hospitals, iran, 2014. Nursing research and practice, 2015, 357140. https://doi.org/10.1155/2015/357140