Implementing Evidence into Practice and Sleep Hygiene Education - Research Paper Example

Implementing Evidence into Practice Introduction The focus of this plan is to present evidence based recommendations on improving daytime sleepiness in aged care residents for implementation into practice in the aged care facility. Analysis of strategies to facilitate research utilisation in regard to the evidence based practices using a specific research utilisation framework will be done. The plan will then describe strategies that can be useful in facilitating the translation of the recommendations into practice. Finally, the plan will present the dissemination plan which will consist of various tactics that will be used in disseminating the research finding to the health care professionals within the aged care facility. Part 1: Recommendations for Evidence-Based Practice Recommendation 1: Sleep hygiene education should be performed to all the staff in the aged care facility Rationale The rationale for this recommendation is that evidence has demonstrated improvement in insomnia for patients who get sleep hygiene education when combined with cognitive behavioral therapy practices (Slater & Steier, 2012). There is strong evidence supporting sleep hygiene behaviours such as positive effects of quite sleep environments, avoiding intake of caffeine, nicotine or alcohol in hours before sleep. With the staff becoming effective in sleep hygiene techniques, the staff members will in turn execute the taught sleep hygiene techniques in the aged care facility (Irwin, Olmstead & Motivala, 2010). Description Sleep hygiene education will focus on health practices such as diet and exercises as well as environmental factors such as noise, light that might affect the sleep either positively or negatively. The goal of sleep hygiene is promotion of better health practices (Martin & Ancoli- Israel, 2009). In this regard, sleep hygiene education will be carried out on sleep schedule, activities, food and substances and also sleep environment. Sleep schedule will include educating the staff on sleep timing. The staff will be educated on ensuring residents sleep at least 7-8 hours at night and not through napping. On activities, staff will be educated on various activities that either facilitate or inhibit sleep. The staff will be encouraged to ensure residents exercise early in the day and avoid bright lights in hours just before bedtime and that residents, avoid drinks such as nicotine, caffeine and other stimulant in hours before bedtime since the substances activate neurobiological systems that maintain wakefulness (Dowson et al, 2010). The staff will also be educated on ensuring that residents eat their meals early enough before bedtime and limit their liquids intake to prevent sleep interruptions because of urinations (Martin & Ancoli- Israel, 2009). For sleep environment, the staff will be educated on ensuring that the sleeping rooms are quiet, dark and cool since noise, light and uncomfortable temperatures disrupt constant sleep. The recommendation will be implemented by the staff at the care facility practicing the taught sleep hygiene techniques for instance through ensuring that the rooms are quite during sleeping time and that the residents take their meals hours before the sleep time (Deschenes & McCurry, 2009). Some of the barriers to implementation of this recommendation include costs and timelines of the implementing this recommendation. Educating the staff on sleep hygiene may be costly for the organisation and may also take time. Owing to the heavy workload that the healthcare providers in the care facility have, it may be somehow overwhelming for them to attend education sessions. Secondly, this could be too costly to have real practical value. Ethical considerations include that the staff at the care facility may feel that the evidence based practice goes against their nursing professional values since even if evidence based practice acknowledges nursing professional values, the implication of authenticated scientific evidence is the foundation aspect in evidence based practice which might end up overshadowing nursing professional value (Holland & Rees, 2010). The hierarchy of level of evidence is level 1. This recommendation will be evaluated through ongoing assessment of residents to prescriptions sleep hygiene. The expected outcomes include improved quality and quantity of sleep at night as reported by the staff and patients as well. Recommendation 2: Nursing staff should reinforce use of continuous positive airway pressure (CPAP) for patients diagnosed with sleep disorder Rationale Excessive daytime sleepiness is the most common symptom of sleep apnea and CPAP is the most effective treatment for sleep apnea. Evidence indicates that continuous positive airway pressure (CPAP) reduces daytime sleepiness. Studies also indicate that in individuals with sleep apnea, continuous positive airway pressure (CPAP) decreases blood pressure during the night and at night as well. Studies have also shown that CPAP is effective in treatment of obstructive sleep apnea (Boulos & Murray, 2010). Description In continuous positive airway pressure (CPAP), the patient wears a face/nasal mask when sleeping. The mask is connected to a pump that enables free flow of air within the nasal passages and this maintains open airway. Nursing staff should reinforce use of CPAP by educating the patients regarding the use, cleaning and maintenance of positive airway pressure and equipment and masks (Dowson et al, 2010). The nurses at the care facility may conduct long-term reinforcement by assessing the compliance of the individuals at the care facility with CPAP therapy for sleep disorder to evaluate the efficacy and this should be evaluated during the initial week of treatment. It is expected that all patients will greatly benefit from positive reinforcement when attempting to get used to nightly utilisation of positive airway pressure equipment. The nurses should frequently monitor masks for minor adjustments and assist the patients if they encounter any problems especially during the acclimatization duration (Boulos & Murray, 2010). This recommendation can be implemented by the staff reinforcing and educating the people in the care facility on how to use the equipment and conducting night supervisions to find out if the individuals with sleep disorders and using and wearing the CPAP appropriately (Schwartz et al, 2009). Some of the barriers to implementation of this recommendation include the low skills among the staff in regard to competency in using CPAP and the healthcare providers and the management becoming too overwhelmed by the enormous information sources. There is a possible ethical susceptibility when the individuals at the care facility get the treatment according to the evidence and not in accordance with the clinical guidelines. Accordingly, the persons at the care facility as well as their families should be informed regarding the recommended practice. Nurses and other healthcare practitioners at the care facility should only offer advice to patients about the evidence based practices but should not try to coerce the aged or their families into accepting the treatment. According to Holland & Rees (2010) patients or their legal decision-makers should make their own decisions concerning the evidence-based treatment practices. The hierarchy of level of evidence is level 1. The recommendation can be evaluated using Pittsburgh Sleep Quality Index which will measure sleep disturbances and normal sleep habits in the patients within the care facility. The Pittsburgh Sleep Quality Index will inform if the sleep quality has improved through reduced sleep disturbances among the persons in the elderly care facility and them having normal sleep habits. The expected outcome is that the elderly in the care facility will maintain optimal state of alertness during daytime and optimal quality and quantity of sleep during the night (Deschenes & McCurry, 2009). Recommendation 3: Nurses in individual nursing units should be carrying out environmental inspections on the noise level in the night hours and come up with strategies to lower sleep disruption due to noise and care patterns Rationale According to Martin & Ancoli (2009) patients in aged care facilities should not be exposed to noises over 35-40 decibels. Nonetheless, studies should that the level of noise within aged care facilities normally considerably surpasses 60 decibels even at night when the patients are sleeping. Noise levels within this range are bound to cause sleep disruptions and many studies show that noise is responsible for increased lack of sleep. Accordingly, this recommendation will see that the noise levels in the care facility during the night are reduced and this will lower sleep disruptions for the people and hence reduce excessive daytime sleepiness in the care facility (Martin & Ancoli, 2009). Description Some of environmental source of noise at night in aged care facilities include people talking, mechanical noises and also healthcare providers doing things like pushing medical carts and walking nosily in the facility rooms. These noises are linked to agitated behavior and disturbed sleep. This recommendation can be implemented be nurses always ensuring that noise levels in their nursing units are minimized as much as possible. Some of the barriers to implementation of this recommendation encompass perception of the research recommendation by the staff members (Deschenes & McCurry, 2009). Healthcare providers in the care facility may find it difficult to balance evidence with other competing influences which may consist of them lacking ideas on where to access pertinent tailored information to validate the authenticity of this recommendation. In addition, decision making at the care facility may be slow which may be a hindrance to the implementation of this recommendation. According to Pavlish (2011) the recommendations should have approval from the national committee and also the staff members at the care facility are supposed to follow health practice guideline when using the evidence based recommendations. Finally, implementation of the evidence based recommendation is supposed to be informed and reflect best practices because health care providers are professionally and morally obligated to have their decisions reflect the best clinical and nursing practices (Holland & Rees, 2010). The hierarchy of evidence in this recommendation is level 3. Just like in the second recommendation, this recommendation can be evaluated using Pittsburgh Sleep Quality Index which will measure sleep disturbances and normal sleep habits in the patients within the care facility. The Pittsburgh Sleep Quality Index will assess whether sleep disturbances among the persons in the elderly care facility have reduced. The expected outcome of this strategy is to have reduced night sleep disturbances due to reduced noise levels at night. Part 2: Strategies to Facilitate Research Utilisation Task 1 The Promoting Action on Research Implementation in Health Services Framework (PARIHS) PARIHS is a conceptual model that describes research implementation into practice. Key features of this model include: evidence, context and facilitation. Evidence: This is the combination of research, clinical experience, patient experience as well as local data. For every form of evidence, there are various conditions of evidence. For instance, a well conducted research includes clinical experience being decision aspect; the relevance of the patient experience and evaluation and reflection of local information. Context: This refers to the setting where individuals receive healthcare services and in this case it is the aged care facility. Context is composed of three themes namely; culture, leadership and assessment. A culture that values workers and customer, leadership in effective teamwork and using various techniques in evaluation illustrates an example of high context. Facilitation: The facilitators have the responsibility of enabling, helping, influencing and persuading change practices. Facilitation includes three themes namely; purpose, roles and skills and attributes. The advantage of PARIHS model is that it identifies facilitation as being the key aspect in the research usage process and provides a lot details and information in establishing the probability of success basing on the predictive arrangement of the framework. The model guides research by explaining factors and aspects allied to use of research and practice. A study by Harris et al (2013) successfully used PARIHS model in a research on changing practice to support self-management and recovery in mental illness. Task 2 Educational outreach visits: Trained people can visit the aged care facility and offer face-to-face information regarding practice change and in this case the recommended practices. Use of opinion leaders: opinion leaders have the ability to influence the other team member due to their ability to relate with other and present their ideas to their colleagues. The opinion leaders should conduct meetings in order to share everything regarding the research as well as answer any questions other health care provider may be having about the research because opinion leaders have the required expertise to tackle this. Seminars and meetings: Seminars and meetings have been shown to have major influence on behaviour of health care practitioners. Therefore, seminars and meetings will be conducted as this will provide a platform for the staff members in the care facility to be educated on the recommended evidence based practices. Reminders: Prompts can be set within the care facility for alerting healthcare providers at the facility to carry out the recommended evidence based practices. This can be through posters and stickers in charts and facility’s communication boards (Wilson, 2010). Core Groups: A Core group includes a group of health care practitioners who share a common goal of facilitating implementation of evidence based practices. Since health care professionals are likely to share information with their workmates, core groups will be effective in disseminating information with their colleagues and hence facilitate adoption of the recommended evidence based practices. Part 3: Dissemination Plan Dissemination of research finding is a critical element of the research process because if enables the research benefits to be communicated to practitioners, other researchers and community at large. Research is only valuable if the researcher informs people about the research by disseminating the findings and recommendations to as wide audience as possible (Baylor et al., 2013). Therefore, after conducting the research one needs to communicate the findings to the peers, workmates and other individuals who have interests in the study subject. Therefore, research dissemination entails ensuring that the target audience knows about the research findings. Results can be disseminated through publicising the findings on different forums such as report, internet, and posters and by presenting the findings at conferences or even informal meetings (Baylor et al., 2013). The findings of this research will be disseminated through publication of the research findings on the website of the aged care facility. This will ensure that all staff members have access to the findings through the internet because all staff members can successfully log in the care facility’s website and thus they will easily access the results. Staff members will also be sent the findings in their emails and hence whenever a staff member (Baylor et al., 2013). The second way of disseminating the research findings will be through conferences, seminar as well as meetings which will provide a formal platform for the results to be shared among the staff. This will also provide a platform for staff members to make enquiries regarding the finding and the research as well. Finally, the research findings will be disseminated on posters and leaflets that will be posted in the care facility’s conference rooms, waiting bays and walls of various rooms in the care facility. Through the three methods, all the staff members in care facility as well as the management will have an access to the research findings (Baylor et al., 2013). Conclusion Recommendations for evidence based practice include; Sleep hygiene education on staff members, healthcare practitioners in the facility reinforcing use of continuous positive airway pressure (CPAP) for patients diagnosed with sleep disorder and nurses carrying out environmental inspections on the noise level in the facility during the night. The research utilization framework used is the Promoting Action on Research Implementation in Health Services Framework whose key elements are: evidence, context and facilitation. in conclusion, the research findings will be disseminated through publication of the research findings on the website of the aged care facility, in conferences, seminars and meetings as well as on posters and leaflets that will be posted in different areas within the care facility. References Andrew T, Bell J, Vitry A et al. (2014). Analgesic use, pain and daytime sedation in people with and without dementia in aged care facilities: a cross-sectional, multisite, epidemiological study protocol. BMJ Open. 5(6): DOI:10.1136/bmjopen-2014-005757. Blake, Jacqueline and Kerr, Don and Gururajan, Raj (2010) Development of knowledge management support for the sleep disorder diagnosis process. In: ACIS 2010: 21st Australasian Conference on Information Systems: Information Systems: Defining and Establishing a High Impact Discipline, 1-3 Dec 2010, Brisbane, Australia. 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. Boulos M & Murray B. (2010). Current evaluation and management of excessive daytime sleepiness. Can J Neurol Sci. 37(2):167-76. Deschenes C & McCurry S. (2009). Current Treatments for Sleep Disturbances in Individuals with Dementia. Curr Psychiatry Rep. 11(1): 20–26. Dowson L, Moore K, Ledgerwood K & Dow B. (2010). Sleep in residential aged care: A review of the literature. Australian Journal Of Advanced Nursing. 29(4): 11-19. Harris M,  Jones P, Heartfield M, Allstrom M , Hancock J,  Lawn S & Battersby M., 2013, Changing practice to support self-management and recovery in mental illness: application of an implementation model, Australian Journal of Primary Health. 1(2): http://dx.doi.org/10.1071/PY13103. Holland, K & Rees, C. (2010). Nursing Research and Evidence-Based Practice Skills. Oxford: Oxford University Press. Irwin M, Olmstead R & Motivala S. (2010). Augmenting Immune Responses to Varicella Zoster Virus in Older Adults: A Randomized, Controlled Trial of Tai Chi. The American Geriatrics Society. 55:511–551. Martin J & Ancoli- Israel S. (2009). Sleep Disturbances in Long-Term Care. Clin Geriatr Med. 24(1): 39–vi. DOI:  10.1016/j.cger.2007.08.001. McCurry S, Gibbons L, Logsdon R, Vitiello M & Teri L. (2009). Insomnia In Caregivers Of Persons With Dementia: Who Is At Risk And What Can Be Done About It?Sleep Med Clin. 4(4): 519–526. 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. Schwartz J, Roth T, Hirshkowitz M, Wright J. (2009). Recognition and Management of Excessive Sleepiness in the Primary Care Setting. J Clin Psychiatry. 11(5): 197–204. Slater G & Steier J. (2012). Excessive daytime sleepiness in sleep disorders. J Thorac Dis. 4(6): 608–616. DOI:  10.3978/j.issn.2072-1439.2012.10.07. Wensing M, Wollersheim H, & Grol R, 2009, Organizational interventions to implement improvements in patient care: a structured review of reviews. Implement Science.1(2). Wilson P. (2010). Disseminating research findings: what should researchers do? A systematic scoping review of conceptual frameworks. Implement Sci. 5 (91). DOI; 10.1186/1748- 5908-5-91. Read More