Identifying Recommendations for Practice for Healthcare Providers - Assignment Example

Student Name: Student Number: Part 2: Identifying Recommendations for Practice (25 marks) Recommendation for Nursing Practice (1): Healthcare providers should be retrained on blood pressure measurement techniques Healthcare providers should be retrained by competent observers using standardised programs with audiovisual tapes and simulation activities that test and retest accuracy in blood pressure measurement to ensure competency of the healthcare providers in blood pressure measurement (Bland & Ousey, 2012). Evidence Joshua (2012) explains that correct blood pressure measurement cannot be achieved without cautious attention to all steps in the procedure and retraining. Retraining should be regular and it entails competency in cuff selection, correct patient positioning, no talking, and accurate observation of the blood pressure level through auditory or visual evaluation. With appropriate and frequent training, healthcare providers can measure blood pressure appropriately and thus the retraining should include training on how to appropriately use the devices used in blood pressure measurements (Henry et al., 2013). Rationale Retraining of healthcare provides on blood pressure measurement is necessary to ensure they are competent in the clinical skill and thus avoid errors that can lead to wrong diagnosis. Studies indicate that regular training of healthcare providers in blood pressure measurement reduces errors (Joshua, 2012). Studies indicate that training healthcare workers regularly on blood pressure measurement enable them to appropriately calibrate the devices as per set standards, appropriately position the patients, choose the correct cuff size, obtain valid and reliable measurement, record the measurement accurately as well as report abnormal blood pressure levels appropriately (Bland & Ousey, 2012). Recommendation for Nursing Practice (2): Automated Methods for measuring blood pressure should be adopted Automated blood pressure measurement techniques include use of techniques such as automated oscollometric blood pressure devices to measure blood pressure. Evidence According to Sheldon (2010) automated blood pressure measurement techniques are increasing being utilised in office blood pressure measurement and also home and ambulatory monitoring. Kapse (2013) further explains that automated blood measurement techniques are more accurate in that multiple measurements can be taken and thus reduce occurrence of errors during blood pressure measurements. Studies indicate that due to automation aspect, automated blood pressure measurements devices remove numerous sources of errors and thus improve overall accuracy of blood pressure measurements but it is necessary to ensure the devices are validated against established standards (Hubbell, 2014). Rationale Blood pressure measurement is a significant indicator of the existing clinical condition in patients and thus accurate blood pressure measurement is important in classification of individuals, to establish blood pressure-allied risks and in guiding management as well (Kapse, 2013). Several studies indicate that automatic blood pressure measurements have advantages of eliminating observer errors, minimising the white coat effect and also increase the number of reading because multiple measurements can be taken (Hubbell, 2014). As studies indicate, automatic blood pressure measurements can be used in office blood pressure measurement as well as in home and ambulatory monitoring. Adopting use of automatic blood pressure measurement provides an opportunity of avoiding costly and repetitive training of healthcare practitioners in use of convectional blood pressure devices which is necessary in order to diminish observer errors (Joshua, 2012). Recommendation for Nursing Practice (3): Healthcare providers should always prepare the patients adequately before taking blood pressure measurements Patient/subject preparation includes ensuring the patient is relaxed, seated comfortably, clothes covering the cuff placement locating are removed and such because these factors can cause deviations in blood pressure measurements. Evidence According to Sheldon (2010), preparing subjects appropriately before taking the blood pressure measurements minimises error because factors such as exercise, muscle tension, talking, arm positioning and noise can cause significant deviations in blood pressure measurements. Study conducted by Shau & Bhaskran (2010) established that when the patients are relaxed, do not talk during measurements; preferably five minutes ought to elapse prior to taking the first reading, and the patients sat comfortably, legs crossed and back and arm supported to ensure the middle of the cuff is on the upper arm and thus at the level of the right atrium; blood pressure measurement were more accurate when compared to patients who were not prepared before taking the measurements (Shau & Bhaskran, 2010). Rationale Adequate preparation of patients before taking blood pressure ensures more accurate measurements because deviations in measurements are minimized (Jansen, 2012). Studies indicate that when patients are adequately prepared and are more relaxed and also since preparation involves ensuring that patients are at the right position, there is less likelihood of errors occurring because factors that cause deviations are reduced (Shau & Bhaskran, 2010). Therefore, healthcare providers should prepare patients in regard to ensuring that the arm is positioned appropriately, there is no talking, the patient is relaxed, and there is no clothing on the cuff placement location and such before taking the blood pressure measurements (Bland & Ousey, 2012). Part 3: Strategies to Facilitate Research Utilisation (25 marks) The Knowledge-to-Action Process Framework (KTA) KTA framework is a framework that was solely established to facilitate research use by patients, healthcare practitioners and public as well. KTA has two components; knowledge creation and action. In this case, knowledge refers to the research based knowledge. Knowledge creation has three phases that include: knowledge inquiry, knowledge synthesis and knowledge products. Knowledge inquiry involves conducting the research, knowledge synthesis is synthesising the researched knowledge into the knowledge product (Ellen, 2012). The requirements intended knowledge users are incorporated within all phases of knowledge creating and the intended message is customised and then disseminated using a procedure that can reach the intended knowledge users suitably (Ellen, 2012). The action cycle of the KTA represents activities that are done to apply the created knowledge. The action cycle starts with identifying problems that can be solved using the created knowledge. Appraisal and verification of the knowledge is necessary before the knowledge is applied to the problem and then the knowledge is implemented to fit the context. After implementation of the knowledge, any barriers and facilitators associated with the knowledge, the intended adopters of the knowledge and also the setting where the knowledge will be used are assessed. The information is then used to develop and execute the plan and strategies to facilitate and promote awareness and knowledge implementation and then monitoring of knowledge use is done. This step determines the efficiency of strategies and plans to enable suitable modifications to be done if required. The outcomes are then evaluated and the plan updated to sustain use of the researched knowledge within the changing setting with time (Ellen, 2012). KTA framework has been used in healthcare fields to apply what is learnt through research to the practice setting. For instance, the framework has been used in healthcare practice where the healthcare providers make decisions founded on integration of research evidence with clinical knowledge (Ellen, 2012). Strategies to facilitate translation of practice recommendations into practice 1. Use of Opinion Leaders and Change Champions Change champions and opinion leaders are highly regarded people in the healthcare setting who have the ability to influence the practice of other healthcare providers due to their expertise and passion regarding innovation and are wholly dedicated to improving quality care and they also have a good relationship with their peers (Titler, 2008). Opinion leaders and change champions are very important when implementing innovations because they disseminate information, encourage their peers to adopt the innovation and make plans to orient and illustrate to other healthcare providers regarding the innovation. Change champions and opinion leaders are very effective and influential due to their firm believe in the idea, are unrelenting and rebuffs do not discourage them. According to NHMRC (2010) healthcare providers prefer interpersonal communication with their colleagues and thus a number of change champions and opinion leaders should be selected to guide the ratification of the evidence based practices. The opinion leaders and change champions should then hold meetings, conferences and seminars regularly to tackle any question their peers may be having regarding the evidence based practice and provider direction if necessary (Titler, 2008). 2. Holding Seminars and Conferences requiring active Participation According to NHMRC (2010) seminars and conferences where the healthcare providers participate actively through workshops and follow ups have been shown to have a big influence on the behaviour of healthcare providers. Basing on research evidence and ideologies of adult learning, for the seminars and conferences to be successful in influencing the behaviour of the healthcare practitioners, they should be planned basing on the following principles: The key goal of the recommended activities should be improving the quality of patient care The content of all recommended activities should illustrate high clinical and ethical standards The healthcare providers should take part in planning of the recommended activities A learning requirements evaluation should be carried out and the activity should be assessed Accordingly, seminars and conferences should be held where the healthcare providers will be educated on the recommended practices and follow ups conducted in order to influence them into adopting the practices (Wensing et al., 2009). 3. Use of Core Groups Core groups refer to groups of selected healthcare providers with a similar goal to disseminate information regarding the recommended practices and also facilitate the other healthcare providers within their units to have practice changes. Healthcare providers prefer social interactions and their colleagues to be their source of information and hence using the core groups to facilitate the adoption of evidence based practices can be extremely effective (Wensing et al., 2009). Basically, members of core groups are supposed to come from different shifts and days of week and be informed adequately on the scientific foundation for the evidence based practice: core group members should be educated and assisted in using the recommended evidence based practices by the opinion leaders and change champions in the institution. Consequently, all core group members have the responsibility of communicating evidence based information and impacting change among their colleagues. The core group members disseminate information regarding the evidence based practices to their peers, reinforce the practice change to the peers regularly and also provide positive feedback to healthcare providers who align their practice with the evidence base. According to Titler (2008), use of core groups to facilitate practice change is so successful and results to a high number of healthcare providers adopting evidence based practices. Part 4: Ethical Considerations and Evidence-Based Practice (15 marks) Ethical considerations in regard to evidence based practice include the potential ethical vulnerability if patients do not get treatment as per the clinical practice guidelines but as per the evidence based practice. Therefore, it is necessary for the patients to be offered as much information as they seek and in a way that is suitable to their culture and level of education as well. Healthcare providers should only advice patients regarding the evidence based treatment and not coerce the patients and thus patients are supposed to be encouraged to make their own decisions regarding the evidence-based treatment. The principles of healthcare ethics require healthcare providers to inform patients regarding any risks allied to the medical procedures and hence the healthcare providers should inform patients regarding any risks allied to the evidence based practices (Holland & Rees, 2010). In addition, decisions to implement the evidence based practices are supposed to be shared with the patients and their families since a patient has a right to make decisions regarding the treatment they are receiving. As a result, patients have the right to receive information about the changes in practice because principles of healthcare ethics require patients to be involved in their care. The patient can decide to accept the changes in nursing care or reject and if a patient rejects the evidence based changes in practice, their autonomy should be respected (Holland & Rees, 2010). Other ethical considerations are that the healthcare providers may feel that the evidence based practice contradicts their nursing professional values. This is because even though evidence based practice acknowledges nursing professional values, the connotation of authenticated scientific evidence is the underpinning aspect in evidence based practice and this may overshadow nursing professional values. According to Pavlish et al., (2011), the evidence based practice should complement the set professional values of the healthcare practitioners but not supersede the values. Still, the decision to implement the evidence based practices should be informed and reflect best practices since healthcare practitioners have the professional and moral obligation to have their decisions reflect the best clinical and nursing practices. Finally, the studies used in evidence based practices should have been approved by the national committee and also healthcare providers should follow clinical practice guidelines when using the evidence based practices (Pavlish et al., 2011). Part 5: Identifying and Evaluating Outcomes (15 marks) Recommendation for Practice 1 Outcome Healthcare providers will be competent in blood pressure measurement Measure Random observations will be carried out when healthcare providers are measuring blood pressure to assess if they can position the patients correctly, select the right cuff size, obtain valid and reliable measurements and record the measurement accurately. Observation, questionnaires and interviews will be used to evaluate the knowledge of correct procedure of blood pressure measurement (Henry et al., 2013). The questionnaires and interviews should cover aspects such as assessing their knowledge in general blood measurement techniques, interpretations of the measurements which should also include their understanding of the normal blood pressure variability due to aspects such as exercises or patients being under medication that can affect blood pressure (Henry et al., 2013). Overall implementation of the recommendation could be evaluated by assessing if healthcare providers use the required skills when taking blood pressure measurements. Recommendation for Practice 2 Outcome The institution will buy more automatic blood measurement devices and in turn healthcare workers will use them instead of the convectional manual devices Measure Direct observation will be used where the number of the new automatic devices will be recorded. Overall implementation of the recommendation could be evaluated by assessing if the institution has purchased more automatic devices. Recommendation for Practice 3 Outcome There will be reduced errors in blood pressure readings Measure A record of blood pressure measurements for the patients can be evaluated to assess the level of deviations because consistent blood measurements in one patient indicate accurate reading while inconsistent readings in one patient indicate errors in blood pressure measurement. Overall implementation of the recommendation could be evaluated by assessing if there are reduced errors in blood pressure measurements. Part 6: Disseminating Evidence-Based Practice Outcomes (10 marks) Dissemination of the research findings involves making sure that the target audience gets to know regarding the findings and the result dissemination is facilitated by advertising and publicizing the results. The target audience should be informed of the results and ensure that the results are availed within the reach of everybody who is relevant to the research. There are several methods that can be utilized in informing the target audience of the availability of results findings. The methods rely on informing the healthcare providers directly (Baylor et al., 2013). In this case, the research findings will be published in the health institution’s website to ensure that all members of staff are able to access the results through the internet. The results findings will also be produced in form of posters and leaflets and will be posted in the hospital’s waiting rooms and wards and this will ensure that everyone in the institution gets access to the results. Seminars and staff meetings sessions will also be used to disseminate results because this will provide a formal mechanism to share the findings. More importantly, this will allow the healthcare providers to ask any questions they have regarding the findings where their questions will be answered thus enabling the healthcare workers to be further informed regarding the research (Baylor et al., 2013). References Baylor A, Muzoora C, Bwana M, Kembabazi A, Haberer J.E., et al., (2013), Dissemination of Research Findings to Research Participants Living with HIV in Rural Uganda: Challenges and Rewards. PLOS Medicine.10(3): e1001397. Doi:10.1371/journal.pmed.1001397. Bland, M & Ousey, K. (2012). Preparing students to competently measure blood pressure in the real-world environment: A comparison between New Zealand and the United Kingdom. Nurse Education in Practice. 12(1): 28-35. Ellen M, (2012), Knowledge Translation Framework for Ageing and Health, Retrieved from . Henry G, Holmboe E, Frankel R. (2013). Evidence-based competencies for improving communication skills in graduate medical education: A review with suggestions for implementation. Medical Teacher, 1-9. Holland, K & Rees, C. (2010). Nursing Research and Evidence-Based Practice Skills. Oxford: Oxford University Press. Hubbell, J. (2014). Comparison of invasive and oscillometric blood pressure measurement techniques in anesthetized sheep, goats, and cattle. Anaesth Analg. 41(2):174-85. doi: 10.1111/vaa.12101 Jansen, R. (2012). Evaluation of skills and knowledge on orthostatic blood pressure measurements in elderly patients. Age Ageing. 31(3): 211-226 Joshua, S. (2012). Auscultatory versus oscillometric blood pressure measurements in teens. The Journal of Clinical Hypertension. 19-22. http://www.ashabstracts.com/abstract.asp?MeetingID=786&id=98855 Kapse, C. & Patil, B. (2013). Auscultatory and oscillometric methods of blood pressure measurement. International Journal of Engineering Research and Applications. 3(2): 528-533. http://www.ijera.com/papers/Vol3_issue2/CI32528533.pdf Landgraf, J., Wishner, S & Kloner, R. (2010). Comparison of automated oscillometric versus auscultatory blood pressure measurement. American Journal Cardiology. 106(3): 386-388. doi: 10.1016/j.amjcard.2010.03.040. National Health and Medical Research Council (NHMRC) (2010). A guide to the development, implementation and evaluation of clinical practice guidelines. Canberra: National Health and Medical Research Council. Pavlish, C., Brown-Saltzman, K., Hersh, M., Shirk, M. and Rounkle, A. (2011). Nursing Priorities, Actions, and Regrets for Ethical Situations in Clinical Practice. Journal of Nursing Scholarship. 43,385–395. Doi: 10.1111/j.1547-5069.2011.01422.x Titler M, 2008, Patient Safety and Quality: An Evidence-Based Handbook for Nurses, New York: Agency for Healthcare Research and Quality. Shau, D. & Bhaskran, M. (2010). Palpatory method of measuring diastolic blood pressure. J Anaesthesiology Clinical Pharmacology, 26(4): 528–530. Sheldon, A. (2010). Recommendations for Blood Pressure Measurement in Humans and Experimental Animals. Hypertension. 45: 142-161. Wensing M, Wollersheim H, & Grol R, 2009, Organizational interventions to implement improvements in patient care: a structured review of reviews. Implement Science.1(2). Marking Criteria Part 1: ePBL Group Discussion (eProblem 2) ePBL Activity 8 0 2 Student did not complete the activity to a satisfactory standard. Student satisfactory submitted the ePBL Activity 1 into the ePBL group discussion forum. ePBL Activity 9 Student did not complete the activity to a satisfactory standard. 2 Minimum of 50 words of students own ideas. Responded to another student’s discussion. Evidence of links with course content. ePBL Activity 10 Student did not complete the activity to a satisfactory standard. 2 Minimum of 50 words of students own ideas. Responded to another student’s discussion. Evidence of links with course content. ePBL Activity 11 Student did not complete the activity to a satisfactory standard. 2 Minimum of 50 words of students own ideas. Responded to another student’s discussion. Evidence of links with course content. ePBL Bonus Marks 2 ( Marks out of /10) Part 2: Identify and describe 3 nursing or patient recommendations 0 – 4.5 5 - 6.5 7 - 7.4 7.5 - 8.4 8.5 - 10 Little or no evidence that student identified nursing related practice recommendations. Partial ability to describe nursing practice recommendations related to the literature. May not have clearly identified and described 3 recommendations, and may not be related to nursing practice. A sound to good description of 3 nursing practice recommendations. Some relevance to the clinical problem and to nursing practice. Overall a good description of 3 nursing practice recommendations. The recommendations were mostly appropriate to the clinical problem and to nursing practice. Student provided an excellent description of 3 nursing practice recommendations based on the literature from assignment 1. The chosen recommendations were very appropriate and relevant to the clinical problem. Rationales for practice recommendations 0 - 6.5 7 - 10.5 10.5 - 12 12 - 13.5 14 - 15 Little or no evidence of a clear rationale for the 3 nursing practice recommendations based on hierarchy of evidence or research criteria. Some consideration of as to the strength of the practice recommendations, however most elements were missing. Sound to good rationales provided for each recommendation. Some elements of hierarchy of evidence were addressed and research criteria. Good rationales for practice recommendations. Addressed all research criteria or hierarchy of evidence; however some aspects were not clearly articulated. Clearly articulated, excellent rationales for practice recommendations, including hierarchy of evidence, and each element of the research criteria. Part 3: Identify and describe a research utilisation framework 0 - 4.5 5 – 6.5 7 – 7.4 7.5 – 8.4 8.5 - 10 Little or no evidence that student was able to identify or describe a research utilisation framework. Ability to identify a research utilisation framework, however limited description and may not be relevant within a nursing context. A sound to good description of a research utilisation framework. A good description of a research utilisation framework relevant within the context of nursing practice. Student was able to describe using only the examples provided. Student was able to identify a research utilisation framework relevant within the context of nursing practice and provided a thorough description, including more elements than examples provided. Strategies to facilitate research utilisation 0-6.5 7-10.5 10.5-12 12-13.5 14-15 Little or no evidence that student could identify strategies to facilitate research utilisation using a specific framework/model. Some ability for student to identify strategies which fit within a research utilisation framework or model. Links often not well made or poorly described. No links to any relevant literature. Sound to good ability for student to consider appropriate strategies linking with the model/framework. Student tended to focus on one area of the model for developing strategies. Some level of critical thinking evident. A good overall attempt at developing strategies by applying the model/framework identified. Most strategies appeared to be relevant with the context of the model and supported by relevant literature. A high level of critical thinking demonstrating an ability to apply the research utilisation framework to the clinical problem. Student able to provide clear links between the two. Student able to apply different aspects to the model for developing strategies. Links with literature strongly evident. Part 4: Ethical considerations & EBP 0 – 6.5 7 – 10.5 10.5 - 12 12 – 13.5 14 - 15 Little or no evidence that student was able to consider ethical considerations within the context of research utilisation. Some ethical considerations identified but were often unrelated to research utilisation or with respect within a model /framework. Sound to good ability for student to demonstrated an understanding of ethical considerations. A good overall level of understanding of ethical considerations relevant research utilisation processes. Student was able to clearly describe a range of ethical considerations related to research utilisation. A high level of critical thinking evident, demonstrating an ability to think broadly from applying research findings into practice, but also within research utilisation processes. Part 5: Implementing and Evaluating Outcomes 0-4.5 5-6.5 7-7.4 7.5-8.4 8.5-10 Little demonstration of understanding of clinical or patient outcomes which could be evaluated effectively. Some ability demonstrated to consider clinical or patient outcomes. No real consideration whether these outcomes could be effectively measured or evaluated. A sound ability for student to identify appropriate clinical and patient outcomes relevant to the practice recommendations. A good overall ability for the student to identify clinical or patient outcomes relevant to the practice recommendations. Was able to identify some measures suitable for the recommendations. Student demonstrated a high level of critical thinking in terms of choosing highly relevant, appropriate, and measurable. Student was able to draw on outcomes identified in the literature. 0-2 2.5 – 3 3.5 3.6 - 4 4 - 5 Evaluation of outcomes to measure effectiveness No clear processes for evaluating clinical outcomes were apparent. A very basic understanding of the processes involved in evaluating outcomes identified. Lack of breadth and depth to description. A sound demonstration of understanding how the outcome measures could be evaluated. Some attempt at relating this to the literature, but ideas not well formed. A sound to good ability for student to identify and describe outcome evaluation within the context of the clinical problem. A good attempt at relating each outcome measure with previous literature. Student demonstrated a high level of understanding of how clinical outcomes could be evaluated. Student was able to clearly link with the literature in terms of how these outcomes have been evaluated previously. 0-4.5 5 – 6.5 7 – 7.4 7.5 – 8.4 8.5 - 10 Part 6: Dissemination of findings Student was not able to describe how findings could be disseminated relevant within a health care environment. A basic description provided of how findings could be disseminated within a health care environment. A sound level of understanding of effective ways of translating evidence based practice findings into practice within a health care environment. A sound to good level of understanding of effective ways in which findings can be translated into the practice environment. Two to 3 ways identified in linked with the nursing literature. A high level of understanding of effective ways in which findings can be translated into the practice environment. Student was able to identify at least 3 ways in which these findings could be communicated. Links with relevant literature evident. Relationships with research utilisation processes outlined. Markers Comments: Markers Name: THIS SECTION INDICATES THE MARKS LOST FOR REFERENCING, WORD LIMIT & SPELLING /GRAMMAR MINUS Over or under word limit by more than 10 % 4 – 5 3.5 2.5 – 3 0 Considerably over or under the word limit Moderately over or under word limit Slightly over or under word limit Adheres to correct word limit Evidence of research, use of suitable references and correct APA style referencing 7 – 10 4 – 6.5 1 – 3 0 Insufficient research/irrelevant research/limited use of evidence and / or absent referencing style Many errors with referencing style or insufficient or irrelevant use of research Minor referencing errors In depth investigation via use of relevant and comprehensive research and correct referencing style Spelling /grammar 4 – 5 3.5 1 – 3 0 Numerous spelling and or errors with grammar Moderate spelling and or grammatical errors Minimal spelling and or grammatical errors No spelling and or grammatical errors MARKS LOST FOR REFERENCING, WORD LIMIT & SPELLING /GRAMMAR MARKS LOST FOR LATE PENALTY (IF RELEVANT – 5 % per day) FINAL MARK ( MARKS AWARDED LESS MARKS LOST) /100 Read More