This course-long reflective journal is a record of weekly reflective narratives for this student which integrates leadership and inquiry into current practice as it applies to the Professional and Practicum course. In this journal, the student reflects on the personal knowledge and skills which have been gained throughout the course. The paper specifically addresses a variable combination in the capstone EBP project on mental illness with experiences in new practice approaches, intra-professional collaboration, health care delivery and clinical systems, ethical considerations in health care, population health concerns, the role of technology in improving health care outcomes, health policy Leadership and economic models as well as health disparities. The student additionally outlines their own discovery about their professional practice, personal strengths and weaknesses which were evident during the course as well as other resources and abilities which can be introduced in order to further influence optimal outcomes on mental illness. The reflections also tackle how this student met the competencies to this course.
Week 1, July 15 th , 2019 – July 21 st , 2019
Objectives :
Understand the detriments of plagiarism in progressing with the EBP proposal research.
Analyze the barriers to achieving a 90% integration of evidence-based practice in nursing profession through the institute of Medicine by 2020 .
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One of my first assignments was to post an article on Plagiarism which entails taking another's ideas, opinions, concepts, and writing and using as one's own. Within the academic field, plagiarism is not only immoral but also impacts negatively on one's integrity and sincerity. Adam, et.al (2017) maintained that nearly all learning institutions consider plagiarism as one of the most severe academic immorality and often come with severe consequences.
From the Student Success Center, Plagiarism - Grand Canyon University (n.d), Plagiarism is not only harmful but also immoral, and if found out, a student's academic progress may be severely hampered. Thus, students should not only conform to their institution's rules and regulation concerning plagiarism but should also uphold integrity and sincerity in their academic work. Unfortunately, I posted on my DQ spot to my own detriment, something which I pledged never to happen again and my professor reconsidered and gave full credit.
On the same week, I spent a lot of time studying the concept of evidence-based practice (EBP) on nursing, and how it relates to my field of studies. It is clear that EBP is a resourceful tool useable not only for purposes of research, but also is utilizable in finding new methods as well as technologies (Ellis, 2016 & LoBiondo-Wood, et al, 2015). EBP is useful in making sound and rational medical decisions which consequently helps in delivering quality health care to patients and improved medical outcomes. Nonetheless, it is often not easy to change clinical Practice due to barriers that hinder and make it hard implementation of EBP in healthcare. Resistance and lack of knowledge and time are the most often mentioned barriers. Resistance is probably because people are used to doing things in a certain way, and they do not want to venture into the unknown. Most clinicians are always heard saying they are busy and have no time to learn new things hence inadequate knowledge on EBP. There are, however, strategies to help facilitate this change and overcome barriers (Khammarnia, et.al, 2015).
The competencies in achieving the objectives in the course were met by developing a mentor-mentee relationship with my Physician’s Assistant that I work with and whom I met in the library at Starbucks and him made to be an important source of support and guide in my nursing education and practice. With my new mentor, we had an in-depth discussion on the goals and potential milestones to cover in this course, besides a review of my ideas and perspectives for this course.
Week 2, July 22 nd 2019-July 28 th , 2019
Main issue in addressing a solution to evidence-based Nursing Practice
Objectives:
Determine clinical problem or issue faced by the organization and implications for nursing
Discuss first step in addressing and resolving the issue.
During this Week I identified mental illness as a key clinical issue in the health department. Psychiatric disorder is identified as a common disorder that affects individuals’ ability to perform everyday activities. Poor performance in school and work problems in one’s social life are some of the side effects of mental illness. Depression being the topmost characteristic type of mental illness, according to the World Health Organization Statistics. Approximately 17.3 million Americans suffered from an episode of depression in 2017 (Brody, et.al, 2018). Depression has been ranked as the tenth cause of mortality in the US when depression is a treatable disorder. Various interventions are effective in reducing the symptoms of depression when used alone or combined with other approaches. There is a need to apply different intervention strategies, including digital strategies, to address the problem of under treatment and improve outcomes.
Despite the presence of safe and effective methods of treatment, a more significant percentage of patients with depression are frequently undertreated. About 35 percent of depression cases go untreated, while 6 percent are under-treated (Tjia, et.al, 2015). Possible causes of under treatment include delay in seeking help, delayed treatment, over-reliance of medication, non-compliance, and inappropriate treatment. The current treatment approach often fails to consider the chronic-recurrent nature of depression. Studies show that medication is the most advertised and used treatment for depression (Shea, 2015). Medication relieves some of the symptoms of moderate and severe depression, but it does not resolve the underlying problem. Overreliance on medication is the main reason for under-treatment, and yet medication comes with side effects.
Mental health care system, both primary and specialty services, basically rely on psychotherapy and medication to treat depression. Yet, the overreliance on traditional approaches to treatment is one of the contributing factors for the under-treatment of depression (Richards et al., 2018). There is a need for individualized care models and redefining of the care provider-patient relationship. Thus, the question, how can mental health care providers utilize digital mental health interventions to support traditional options such as psychotherapy and medication to improve the outcomes of depression? The first step towards healing from depressed mood which is usually the most difficult is avoiding lonely environments which involve interaction with friends, making oneself happy etc. Although depression drains one energy, personal drive and hope, making it difficult for an individual to take the first steps, it’s important to exploit the remaining reserves in order to take the first step. A change proposal involving the improvement of depression outcomes intervention is thus proposed for this practicum.
Week 3, July 29 th 2019- August 5 th , 2019
Search strategy and Summary of articles on Discussion board
Objectives:
Submit a summary of 6 articles on evidence for practice change
Compare on 2 methods for evaluating evidence
During this week, a search strategy was defined. The search strategy focused on peer-reviewed scholarly articles dated from 2014 to 2019 to support the capstone project. The main database used in the search was EBSCO host because it is a reliable database with thousands of peer-reviewed journals on different nursing issues. The keywords used to find the right articles for the project were depression, under-treatment, depression medication, psychotherapy, and digital technology. The results of the search met the criteria and were useful in the completion of the capstone project.
Beiter et.al (2015) is the first article which was reviewed and found to investigate the potential correlates of depressive disorder, anxiety and stress which were carried out in a sample of college students. The article concludes the need to continually diagnose the mental health status of college students and further tailor treatment programs towards their needs.
Leppink et.al (2016) examines the associations between perceived stress, mental health, and impulse control disorders in young adults to better understand the mental status of the student population. In this article, severe perceived stress is associated with worse academic performance and high rates of impulsive and psychiatric disorders. Proactive stress management is diagnosed as an important means of cushioning performance in academics and boosting mental health.
Thirdly, Zaff, et.al (2016) explores a positive youth development process based on social and emotional competencies which frames some interventions which recognize young people competencies which enhances the understanding of the relations of thoughts, experiences and individuals development in relation to depressive moods.
Another article by Burke et.al (2014) analyses the oppositional defiant disorder considered as a problem in childhood and is also diagnosed to be stable at young adulthood. The disorder is associated with the interference of mental functioning of young children with a great effect to poor employment and academic outcomes.
Biebel (2017) is another article which gives a case study on the experiences of individuals with psychiatric problems receiving post-secondary education supports. This helps to develop an understanding of the needs of psychiatric patients as well as the modification of support initiatives which are effective, compelling and relevant. Finally, Honeycut, et.al (2017) examines the role of state vocational rehabilitation in offering postsecondary education support
to the youth with mental health conditions. This provides a wraparound program for several planning services for mental patients.
During this week, I also reviewed systematic reviews and meta-analyses as the two commonly used methods of evidence evaluation in nursing. A systematic review answers a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria. A meta - analysis is the use of statistical methods to summarize the results of these studies (Juni, 2019).
Week 4, August 6 th , 2019- August 12 th , 2019
Healthcare system in planning EBP implementation
Objectives:
Understand healthcare system at local level for EBP implementation
Research and obtain anecdotal evidence from course mentor for change project
Contrast two change theories and consider which one is appropriate for your EBP project
In week 4, I evaluated the healthcare system for evidenced based practice implementation. Understanding the healthcare system, at the local level is important because this paves way for the implementation of the evidence-based practice in a way which definitely results in the option of the EBP in quite a successful way in the healthcare facility. A good EBP topic is characterized by several factors which determine its adoption such as values, norms, user perceived needs, and relative advantage of the EBP such as social prestige, effectiveness and relevance to the task. Also this is dependent on compatibility and complexity of the EBP topic. Thus understanding the healthcare system at local level enables easy selection of the best EBP topic that is implementable and adoptable.
During this week I also evaluated change theories which can be used to implement the EBP project. The two theories which were considered here are the Kotter’s 8-Step model of change by John Kotter and the Lewin three-step model of change by Kurt Lewin. The three steps in the Lewin change theory model include; unfreezing, transitioning, and refreezing. Kotter’s theory has 8 steps. Lewins model carries a greater sense for EBP project implementation because of its direct use and easier to use compared to Kotter’s. My mentor adopted the Lewin change theory.
Week 5, August 13 th , 2019- August 19 th , 2019
Stakeholder support for change proposal project implementation
Objectives:
Evaluate internal and external stakeholders and why their support is necessary
Evaluate the technology necessary in improving the implementation process and outcomes of EBP project
Evaluate the barriers to adopting the use of this technology.
In this week, I introduced and progressed in u8nderstanding stakeholder management in clinical evidence-based practice. Substantial evidence is available to give the necessity of stakeholder involvement in for management effectiveness in in clinical research. Stakeholder feedback has important value in alerting about the environmental, ethical and social implications. The facility, unit and health care setting are important internal factors comprising of staff, board members, volunteers and donors. The involvement of the internal stakeholders is important because all perceived success of the EBP project is easily judged from the point of satisfaction of these stakeholders.
Additionally, I identified that engaging the right group of stakeholders is important to cause things happen. Since all internal stakeholders work hard to see the progress of the healthcare facility, they are the most crucial factors to consider in propelling change. Stakeholders play an important role in ensuring successful implementation of my evidence based project. Internal stakeholders play a major role in facilitating its successful implementation by providing their skills and knowledge and providing appropriate leadership in the organization to allow for the proposed change. Stakeholders such as healthcare professionals, cadres of employees, administrators and nurses who play both clinical and non-clinical roles play a great role in translating the evidence into actual practice. Nurses work in multidisciplinary teams comprising of anesthesiologists, pharmacists, physicians, physiotherapists and other health specialists directly involved in provision of healthcare services. The organization’s management structure plays a critical role in providing necessary leadership and framework that would facilitate the adoption of proposed change.
External stakeholders such as suppliers, government, patients, and financial institutions also play supportive roles in implementing change by the provision of the required resources. The government for instance provides the infrastructural facilities required in realizing the health care facility. The patients are the end consumers of the healthcare services and thus their support is very key in supporting the EBP project.
In order to gather the necessary support from all stakeholders, I resolved to adopt several approaches such as advocating for support through community coalitions and the media as well as creating awareness about the evidence-based project. Seminars, conferences, journal forums, and other platforms are key in creating interactive engagements.
A number of technologies is available such as the distant care facility of telecare which will not be adopted because of some of its consequences considered in this proposal. The consequences of adopting this in this EBP project include: it cannot be meaningfully be identified as an entity, limited interactions with the patient, and also it has not been considered as ethical in decision-making.
Week 6, August 20 th , 2019- August 26 th , 2019
Proposed solution to addressing the EBP project change solution
Objectives:
Aspects to consider in addressing the EBP project
Impact of the proposal on each aspect and proposed solution to address the problem
Describe the Changes of the solution from the start and factors leading to current perspective
This week I involved myself in many consultations with my mentor through discussions, long phone call conversations and email exchange. Following consultation with my mentor regarding the implementation of the evidence based practice solution; three critical areas that need to be considered include financial, clinical and quality aspects. The evidence based practice solution to the problem of increased application of antipsychotics in the treatment of dementia involved application of non-pharmacological interventions in the treatment of behavioral and psychological symptoms including psychosis. The main financial aspect that was discussed here is how the EBP solution will truncate healthcare costs. The adoption of this project is however expected to reduce health care charges by reducing readmission rates for patients of such issues like dementia while lowering costs on drugs.
In regard to quality aspect, the intervention will help to promote the anticipated patient outcomes such as truncating rate of mortality, promoting the life of patients by lowering readmissions to health facilities. The EBP will give interventions which will promote quality care to reduce adverse health outcomes resulting from the use of antipsychotics for patients of depression while enhancing patient satisfaction.
In regard to clinical aspect, here we consider healthcare staff with defined expertise and knowledge in order to facilitate change implementation for the EBP solution to both in and outpatient settings. The skill mix will be highly considered for a successful implementation of the EBP solution.
The formulated solution from the discussion so far is the use of treatment models for major depression in primary care setting which have demonstrated efficacy and cost-effectiveness. However sustaining evidence-based depression management need organizational and financial solutions. This solution is a focus of improving care on depression in medical settings regarding the adaptability to chronic care model as well as overcoming the challenges in implementing the evidence-based depression care given the clinical, financial and quality aspects.
Week 7, August 27 th 2019-September 2 nd , 2019
Effectiveness of EBP project change and methods of result dissemination
Objectives:
Describe internal and external methods on EBP project results dissemination
Evaluate the importance of reporting your results both internally and externally
Discuss a way in which you can evaluate whether your project made a difference in practice
In week 7, I evaluated the effectiveness of the proposal in addition to result dissemination. The dissemination of EBP based practice results was targeted upon interventions and information to a specific public clinical audience objected to increase and spread the information regarding evidence-based interventions with the intention to enhance better patient outcomes. Effective dissemination is composed of positive engagement of the targeted audience to enhance awareness, understanding as well as motivation to implement in the work place. The internal method that I resolve to use in order to disseminate the EBP is a healthcare board. This board broadly should comprise the employees of the facility, doctors and nurses as well as other professionals. The best method that is appropriate and I can adopt is the face to face delivery which has the advantage of facilitating interaction and feedback to necessary questions.
On the other hand, presentation in conferences, seminars etc are the external method that I would apply. The American Nurses organization conference can provide such a great audience of nurses for effective dissemination. Face to face method can be used to facilitate consultative meetings with other nursing professionals. The communication strategy applied will vary in the internal and external forums in that the hospital board has colleagues which give way to more informal interaction as compared to the Nurses association.
The presentation of the evidence-based results to the board and conference nurses is good in facilitating the sharing of information to the nursing fraternity. This is important in enhancing decision-making capability among the group members in nursing practice while promoting patient outcomes. In addition, presenting the results in this way gives constructive criticism and consequently offering an opportunity to improve them and then implement the change. In this way I will be able to discern if my project made any difference in practice.
Week 8, September 3 rd , 2019- September 9 th , 2019
EBP project variables and Clinical significance
Objectives:
Evaluate dependent and independent variables
Define clinical significance and relate this to how you can use it to support the project positive outcomes .
In week 8, I evaluated the project variables and how I can measure the same. A variable can change or can take more than one value. The independent variable is the precursor while the dependent becomes the consequent. Now, based on my EBP project, my independent variable would be the high stress levels, smooth transition with the help of mentor programs and work place violence. Studies reveal that these variables affect the newly licensed nurses who remain in the work place due to stress and lack confidence. High turnover rates would be my dependent variable would be the high turnover rates among newly licensed nurses.
There are two types of significance used to interpret research studies, statistical significance and clinical significance. One answers the question, Are the statistical results due to random chance? and the other answers the question, Will the results matter to our patients? Statistical significance has to do with the likelihood that a research result is true and not just simply a matter of chance. Clinical significance is an independent interpretation of a research result as practical or meaningful for the patient and thus likely to affect provider behavior (Thompson, 2017). A decrease in turnover rates among newly licensed nurses after introducing education on effects of workplace violence during unit and hospital wide meetings would be considered a clinically significant outcome. Also, if newly licensed nurses are feeling more confident as they transition into practice with the help of mentor programs, I would also consider this to be a clinically significant outcome in the reduction of high turnover rates.
Week 9, September 10 th , 2019- September 16 th 2019
Personal Evaluation and barriers to EBP change proposal
Objectives:
Discuss a personal strength and weakness in regard to professional presentations
Evaluate a method foe improving each strength and weakness and significance of working on such skills for better presentation of findings
Evaluate change as an organizational culture and discuss the barriers to continuity of EBP change and strategies to overcome the barriers .
During this week, I focused on the potential barriers on the implementation of the EBP and its continuity. Health services are subject to frequent changes. Most of the mental health practices have been affected by traditions as well as other haphazard trial and error methods instead of established scientific evidence. Some of the challenges in mental health services are still due to staff perceptions where many objective barriers to change in acute ward settings such as limited resources, intermediate leadership, violence etc. However, despite these perceptions and old traditions, there are possible ways to overcome them, some of which have been put into place (The challenge of change in acute mental health services, 2014) . This paper explores and analyzes some potential barriers towards the implementation of mental health Evidence-Based Practice as well as the strategies to overcome them.
In any organization change is inevitable, as they always try to keep up with the trends provided by the environment. Cultural change is sensitive and needs to be gradually induced. A process needs to be followed for such changes to be successful. It is therefore set in motion in the following ways, invention, process of creating new cultural elements and lastly diffusion. Invention includes creating the idea of EBM citing its benefits and drawbacks. Then providing evidences to support the probability of the success of such projects. Diffusion is all about involving people in the organization, taking up their suggestions and make them feel included.
The potential barriers identified in the implementation of the mental health EBP include: The nature of the evidence in mental psychology, the contribution of the mental health staff to the evidence-based practice, personal characteristics of the mental health officers and organizational factors (Barriers to Evidence-Based Practice, 2014) . These mentioned barriers are general and affect most medical expert.
. EBP in nursing is an integration of research, customer preferences and nursing expertise. It ensures that nurses increase customer satisfaction by providing specific and individualized patient care. Mental health care like any other medical field has its set of individualized characteristics. Despite having its fair share of benefits, the implementation of EBP has some drawbacks. Lack of enough evidence, means that the nurses lack the proper tools, knowledge and skill to support their EBP practices. These nurses then lack the ability to properly conduct and implement their problem statements. The other setback is the personal characteristics of the mental health practitioners.
The strategic link between barriers, implementation as well as the outcomes is always the key towards settling the implementation climate in mental health EBP. Emotional alterations of the working staff due to service changes also have its own attention in regard to how the staff perceives the change. EBP is a new concept, thus requires many hospital to change some of its structures. Nurses have to seek additional training for such programs to be successful. However, some individual are not easily swayed over and may prefer to stick to the old ways. The emotional part in this instance means that when some nurses are not satisfied their input reduces. This can be cited to the low job satisfaction, they will definitely feel ignored, as if their views do not matter.
The challenge now remains on how to build up concrete strategies on how to allow mental health attendants to provide the EBP care as a portion of daily performance. However in order to overcome these barriers possible solutions include the adaptation of a more dynamic type of mental health EBP, increasing the number of mental health researchers, conducting clinical research projects, training mental health officers on necessary skills, integration of the EBP principles into the mental health curricula, as well as offering organizational facilitators ( Canady, 2015) .
References
Adam, L., Anderson, V., & Spronken-Smith, R. (2017). ‘It’s not fair’: policy discourses and students’ understandings of plagiarism in a New Zealand university . Higher Education, 74(1), 17-32.
Barriers to Evidence-Based Practice Utilization in Psychiatric/Mental Health Nursing. (2014, February 1). Retrieved from https://www.researchgate.net/publication/260119065_Barriers_to_Evidence-Based_Practice_Utilization_in_PsychiatricMental_Health_Nursing
Beiter, R . , Nash, R . , McCrady, M . , Rhoades, D . , Linscomb, M . , Clarahan, M . , & Sammut, S . (2015) . The prevalence and correlates of depression, anxiety, and stress in a sample of college students . Journal of affective disorders, 173,
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Canady, V. A. (2015). Online training in EBP comparable to in-person instruction. Mental Health Weekly , 25 (19), 6-7. doi:10.1002/mhw.30181
Ellis, P. (2016). Evidence-based practice in nursing . Learning Matters.
Honeycutt, T . C . , Anand, P . , Rubinstein, M . , & Stern, S . N . (2017) . Public provision of postsecondary education for transition-age youth with mental health conditions . Psychiatric rehabilitation journal, 40(2), 183 .
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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, 1-5. doi: 10.1155/2015/357140
Leppink, E . W . , Odlaug, B . L . , Lust, K . , Christenson, G . , & Grant, J . E . (2016) . The young and the stressed: stress, impulse control, and health in college students.The journal of nervous and mental disease, 204(12), 931-938.
The challenge of change in acute mental health services: measuring staff perceptions of barriers to change and their relationship to job status and satisfaction using a new measure (VOCALISE). (2014, February 20). Retrieved from https://implementationscience.biomedcentral.com/articles/10.1186/1748-5908-9-23
Thompson, C. (2017). What’s the difference between statistical and clinical significance? Retrived from https://nursingeducationexpert.com/difference-statistical-significance-clinical-significance/
Zaff, J . F . , Aasland, K . , McDermott, E . , Carvalho, A . , Joseph, P . , & Pufall Jones, E . (2016) . Exploring positive youth development among young people who leave school without graduating high school: A focus on social and emotional competencies . Qualitative psychology, 3(1), 26 .
