How To Implement an Evidence-Based Practice Change Process

Discovery 

Evidence-Based Practice (EBP) involves identification of a clinical question then seeking and appraising evidence to prove the impact of the question in the clinical practice. Upon determination of the necessity of practice change the next step is integration of evidence with clinical question clinical expertise and patient values and preferences. The final step in EBP is evaluating of outcomes and disseminating the results to ascertain that they yield the desired results. The nursing practice issue related to the topic is workplace hazards; this is because nurses are exposed to various forms of hazards in the process of carrying out their jobs which jeopardize their lives. On a daily basis, nurses are exposed to various forms of injuries, bloodborne pathogen cold and flu germs; and hand washing-related dermatitis. Research by Bureau of Labor Statistics reveals that among the 12.2 million health workers in the society, 5.6 million of them are exposed occupational exposure to bloodborne pathogens. Additionally, the nursing profession has the highest rates of injury that any other profession and the common forms of injury in the profession are 35,000 every year among them being hands, back, shoulders and feet injury. 

The rational for the selection of the topic is that the high number of injuries to which nursing professionals are exposed increases the number of people exposed to diseases and injuries in the contemporary world and worsens the challenge of shortage of workers in the population. Additionally, workplace injury has a negative impact on patient care which in turn inhibits the treatment processes. Furthermore, the problem in the nursing profession discourages the population from pursuing the course which presents a bleak future to the profession and hampers treatment process. The scope of the issue ranges from severe injury to injury in the hands which come as a result of the hand hygiene protocols to which nurses are exposed which in turn leads to an increase in instances of skin diseases. 

Summary 

A nursing professional is exposed to various hazards in the course of their work which have various negative effects on their health conditions. This is because their working environments are full of pathogen and their interaction and handing of blood and body fluids from their patients make it easy for them to contact diseases. Additionally, the working environments of nurses are full of communicable air-borne diseases due to which make it easy for the nursing professionals contact the same. 

PICOT Question 

Aetiology PICOT Question 

Are nursing professionals involved in handling of patients (P) that work five days in a week (I) at a higher risk of occupational hazards (O) that other professionals not directly involved with handling of patients who work the same number of days in a week (B) for a period of 40 years? 

Prevention PICOT Question 

For the nursing professional exposed to workplace hazards (P), does the maintenance of health protocols when handling patients (I) reduce cases of such hazards (O) as compared to those that do not follow recommendations stipulated in health protocols (C)? 

Prognosis/Prevention PICOT Question 

Does lack of following health protocols (I) affect the severity of disease attacks (O) in nursing professionals that have worked in their professions five days a week (P) for 40 years (T)? 

Meaning PICOT Question 

How does nursing professionals exposed to workplace hazards (P) introduced to better working environments (I) perceive their wellbeing (O) at the time of change of working condition? 

Systematic Review 

Bernal, D., Campos-Serna, J., Tobias, A., Vargas-Prada, S., Benavides, F. G., & Serra, C. (2015). Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: a systematic review and meta-analysis.  International journal of nursing studies ,  52 (2), 635-648. https://www.ncbi.nlm.nih.gov/pubmed/25480459 

Smiddy, M. P., O'Connell, R., & Creedon, S. A. (2015). Systematic qualitative literature review of health care workers' compliance with hand hygiene guidelines.  American journal of infection control ,  43 (3), 269-274. https://www.ncbi.nlm.nih.gov/pubmed/25728153 

Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice.  Nursing inquiry ,  24 (4), e12199. https://www.ncbi.nlm.nih.gov/pubmed/28421661 

Other Sources (Scholarly Sources) 

Quinn, M. M., Henneberger, P. K., Braun, B., Delclos, G. L., Fagan, K., Huang, V., ... & Maher, K. A. (2015). Cleaning and disinfecting environmental surfaces in health care: toward an integrated framework for infection and occupational illness prevention.  American journal of infection control ,  43 (5), 424-434. 

Lalloo, D., Demou, E., Stevenson, M., Gaffney, M., & Macdonald, E. B. (2017). Comparison of competency priorities between UK occupational physicians and occupational health nurses.  Occup Environ Med , oemed-2016. 

Pompeii, L., Byrd, A., Delclos, G. L., & Conway, S. H. (2016). The American Association of Occupational Health Nurses’ Respiratory Protection Education Program and Resources Webkit for Occupational Health Professionals.  Workplace health & safety ,  64 (12), 564-572. 

Duncan, S. M., Hyndamn, K., Estabrooks, C. A., Hesketh, K., Humphrey, C. K., Wong, J. S., ... & Giovannetti, P. (2016). Nurses' experience of violence in Alberta and British Columbia hospitals.  Canadian Journal of Nursing Research Archive ,  32 (4). 

Mazurek, J. M., & Weissman, D. N. (2016). Occupational respiratory allergic diseases in healthcare workers. Current allergy and asthma reports, 16(11), 77. 

Wu, Y., Zheng, J., Liu, K., Baggs, J. G., Liu, J., Liu, X., & You, L. (2018). Occupational hazards and injuries’ association with work environments and overtime for nurses in China. Research in nursing & health. 

Huang, H. L., Kung, C. Y., Pan, C. C., Kung, P. T., Wang, S. M., Chou, W. Y., & Tsai, W. C. (2016). Comparing the mortality risks of nursing professionals with diabetes and general patients with diabetes: a nationwide matched cohort study.  BMC public health ,  16 (1), 1054. 

Summary of the Findings 

Nurses experience the highest degree of job-related illnesses and injuries because their responsibilities, work environment and the duties put them at the forefront of such challenges. Some of the common forms of occupational hazards to which nurses are exposed are persistent job-related pain and work overload which in turn leads to stress. The persistent pains to which nurses are exposed are mainly musculoskeletal which affects lower back, knees, shoulder, upper extremity and neck injuries (Lalloo et al., 2015) . Furthermore, nurses are exposed to work overload and high degree of stress which leads to fatigue and burnout; this is because they have to work several shifts in various challenging settings among them being emergency wards and oncology departments. Third, nurses are exposed to communicable and contagious diseases due to exposure to blood-borne pathogens resulting from needle-stick injuries (Bernal et al., 2015) . Fourth, the professionals are exposed to dangers from chemicals among other hazardous substances during, for example, chemotherapy, exposure to latex among others. Finally, nurses in emergency departments are exposed to high levels of on-the-job violence such as verbal abuse and physical violence. 

The Solutions 

One solution to the violence to which nurses are exposed in the course of their work is enactment of policies that ensure zero-tolerance to violence from patients or their relatives. Moreover, the policies should extend to ensure safe working conditions of nurses and provide them with the support they need. Additionally, there should be increased the number of nursing professionals in every medical institution to avoid shortage of such professionals. Finally, nurses should be provided with the right education to enlighten them on occupational hazards to which they are exposed and how they can tackle such. 

Translation 

Practice Guidelines 

One practice guideline that should be enacted in the health sector is to ban manual lifting in all health facilities; this is to avoid putting patients and nurses to various forms of risks and improve safety of either party in the process of provision of healthcare services. The other practice guideline is to ensure strict conformity to Occupational and Safety Health Act of 1970 which ensures that employers in the health sector provide their employees with a healthy and safe working environment and comply with regulations of Occupational Safety and Health Administration (OSHA) ( Quinn et al., 2015) . Finally, every employee in the health sector should comply with employer’s procedures, policies as stipulated in OSHA; This requires that they should use universal precautions, protective equipment at work, ensure careful administration of injections according to policies of the facility and alert the management in case of hazards at work. 

Stakeholders in the Change Process 

The first group of stakeholders in the change process is sponsors; sponsors are people with power and authority and have direct interest in the change process. Initiating sponsors kick off the change process, key sponsors give the ultimate authority, primary sponsors have a central engagement in the change process and secondary sponsors keeps track of the change process. The other stakeholders are the targets who are people that will be affected by the change process; they include the nurses, patients and management of hospitals as a whole. The final stakeholders are both internal and external partners that effect the change process. Some of the partners of interest during the change process are trainers, external consultants and IT professionals who are resourceful to the implementation process. 

Nursing Role in the Change Process 

The role of nursing in the change process is to provide the much needed education and enlightenment during the process to make it easy to effectively implement the changes therein. Nursing provides education to nurses so that they can support doctors and the management to ensure conformity to ethical and moral standards of nursing profession; this improves the standard of care and compassion to ensure that the changes improve working conditions of the nurses. 

Stakeholders 

One of the stakeholders in the nursing profession involved in the change process is the initiative staff who are tasked with the providing the needed leadership and ensuring that there is accountability during the entire process. Secondly, the executives and board of directors is another stakeholder tasked with providing organizational leadership (Smiddy et al., 2015) . Additionally, guarantors help in soliciting funds to support the change process and ensure that the plan proceeds without a hitch. Furthermore, beneficiaries participate in the change process for the benefit of the community and patients. Other stakeholders include researchers and evaluators, volunteers, contributors, community leaders and groups, experts and policy groups. 

Type of cost analysis 

The type of cost analysis required is cost avoidance which will serve to ensure that change is properly managed and costs are kept at the bare minimum to avoid excess costs on those involved. Change process must avoid extra costs which might impose an extra burden to those involved. 

Implementation 

Process for Gaining Permission 

The process of gaining permission begins by confirming whether permission is needed and it is compulsory for subsequent stages, then the source of authority is identified to give the permission. Next, there is acknowledgement of rights needed to gain permission and seeking such rights; this is then followed by planning ahead to get the permission; then contacting the source of authority for the permission and making the necessary negotiations and followed by getting the permission agreement in writing. The specific group involved in the process is implementation committee that is tasked with facilitating implementation process. 

Plan for Education Staff 

The plan for educating staff starts by outlining the ideas that inform the change process and providing evidence towards the same; developing manageable goals and which are credible and right for schools; engaging moral purpose of stakeholders and participants; and building capacity for the change process to ease implementation process. Finally, enough resources should be accumulated to support the entire change process and reviewing of the progress and make adjustments where necessary. The staff involved in the change process will enjoy better working conditions and better social welfare (Slemon, Jenkins & Bungay, 2017) . 

Evaluation 

The outcomes of the trial will be made through memo within the organization where every stakeholder will be informed about the outcome of the same. Additionally, there will be organized departmental meetings to inform every department on the progress and outcome of the change process. Finally, organizational newsletters and magazines will provide a good opportunity to air out stride the organization has made in the change process. 

The next steps are organizing for an organization-wide meeting to deliberate on the findings, solicit for feedback on the change process and invite any suggestions from team members. Finally, the final step will be to carry out research to provide solutions to challenges faced during implementation process. 

References 

Bernal, D., Campos-Serna, J., Tobias, A., Vargas-Prada, S., Benavides, F. G., & Serra, C. (2015). Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides: a systematic review and meta-analysis.  International journal of nursing studies ,  52 (2), 635-648. https://www.ncbi.nlm.nih.gov/pubmed/25480459 

Lalloo, D., Demou, E., Stevenson, M., Gaffney, M., & Macdonald, E. B. (2017). Comparison of competency priorities between UK occupational physicians and occupational health nurses.  Occup Environ Med , oemed-2016. 

Other Sources (Scholarly Sources) 

Quinn, M. M., Henneberger, P. K., Braun, B., Delclos, G. L., Fagan, K., Huang, V., ... & Maher, K. A. (2015). Cleaning and disinfecting environmental surfaces in health care: toward an integrated framework for infection and occupational illness prevention.  American journal of infection control ,  43 (5), 424-434. 

Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice.  Nursing inquiry ,  24 (4), e12199. https://www.ncbi.nlm.nih.gov/pubmed/28421661 

Smiddy, M. P., O'Connell, R., & Creedon, S. A. (2015). Systematic qualitative literature review of health care workers' compliance with hand hygiene guidelines.  American journal of infection control ,  43 (3), 269-274. https://www.ncbi.nlm.nih.gov/pubmed/25728153