Respond to the four
 colleagues. Compare their observations and evaluations of EBP in their health care organizations with your own and offer recommendations for advancing EBP or identify suggestions you will apply in your own practice setting. please provide at least 2 references

1. My organization implements evidence-based practices to prevent catheter-associated urinary tract infections (CAUTI).  The first intervention includes assessing the need for catheter insertion for short-term periods. Patients admitted for surgery often received Foley catheters in place. The current practice is that patients do not have Foley’s in place but use external female and male catheters. If a patient is admitted with a catheter for procedure reasons, the nurse has a standing order to remove it the following morning. Secondly, strict monitoring of urinary catheter care. Catheter care is performed and documented every shift and as needed.

“Evidence-based practice refers to “integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (McEwen, M., & Wills, E. M. 2019, p.255). My organization has been identified as a Magnet facility. The Magnet destination shows the agency has nursing staff in leadership roles. The large nursing leadership allows for support for the implementation of evidence-based practices.

In my organization, I advocate for including evidence-based practices by obtaining research information and presenting it to shared governance. The shared governance will evaluate the presentation, obtain any clarification needed, and then forward it to the leadership. Leadership meets monthly, making decisions on the new proposed practice. The typical timeframe ranges from 3 to 6 months, depending on the immediate need. The CAUTI procedures were evaluated after 30, 60, and 90 days to determine the relation to eliminating CAUTIs. The practices were proven to be effective based on the 40% decrease in hospital-acquired CAUTIs.

2. Evidence-based practice involves the utilization of the most up-to-date, credible research data and clinical knowledge and tailoring it to a patient based on their unique presentation. This practice type is vital to nurses and the nursing field due to the many benefits it embodies. It bridges the gap between nursing literacy, research, and application, promotes the progress of the nursing discipline, regulates nursing practice, facilitates patient outcomes, elevates care quality, and makes healthcare affordable. Abu-Baker et al. (2021) pointed out that the latest research information should be the basis of a nurse’s clinical judgment. Individuals with mental health disorders are not always adherent to their treatment plans (Semahegn et al., 2020). Effective communication and good rapport between the patient and the provider is necessary to promote patient acknowledgment and compliance with the recommended treatment plans and resources provided. Maintaining this relationship can be challenging for mental health patients and their providers. Oftentimes, these patients may experience isolation, exacerbations of symptoms, and hospitalization when they do not understand or follow the instructions of the professionals. It has been observed that patients become better and adhere to their care plans. According to Papageorgiou et al.  (2017), patients are more involved in their care when there is a good relationship between them and their caregivers due to the affirmation given. In my practice, care delivery by nurses involves the use of evidence-based processes that promote effective communication. These strategies include active listening, acknowledging, paraphrasing, clarifying, open-ended questions, restating, summarizing, concentrating, giving leads, reflecting, silence, and positive body language. When therapeutic communication was reinforced in our facility, we noticed a positive shift in patient outcomes. We progressed to facilitating better rapport with patients and observed more motivation in patients to be involved in their treatment regime, especially towards med adherence. At the end of every week, I provided my facilities project team with my data on patient outcomes. I included the communication methods utilized, the number of patients who participated actively in their treatment, number of those who were med adherent and those who were not. Finally, we analyzed the results from incorporating evidence-based practice as it relates to improving treatment adherence daily over the course of a month. By exploring the most recent evidence-based information with my colleagues, staff, hospital administration, and patients, I contribute to the advancement of evidence-based practice in my facility.

3. This involves providing holistic, quality care based on the most updated research and knowledge instead of traditional methods, personal beliefs, or advice from colleagues. Healthcare and the care patients receive have greatly improved through the EBP approach. Nurses can be able to refine their clinical practice experience by processing, collecting, and implementing research findings. An example of EBP which I witnessed and participated in which was very successful and produced an outstanding patient outcome was at my previous job. Some time in my past job it was observed that a lot of diabetic patients’ blood sugar was so elevated to the extent that their sliding scales were increased, and later their blood sugar started going too low and some were going into hypoglycemia, one even had a seizure episode as a result of low blood sugar. During that period, there was a high staff turnover, and many new nurses were hired. So, we had a general meeting and it was mandated that before insulin is administered to any patient, two nurses have to witness it drawn.  The pharmacists entered it the pyxis in such a way that a second nurse had to witness the pyxis for the primary nurse before insulin could be drawn. This new approach was a game changer. In about a month, most diabetic patients’ blood sugar was stable. The episode of hypo/hyperglycemia was drastically reduced. Evaluating the above incident and EBP, it seemed like some nurses were either not giving the right doses of insulin to those patients, or not giving them any insulin at all. When the decision was taken for nurses to witness each other draw insulin, the problem was resolved. This EBP was very effective as it was taken very seriously by the authority of the entire hospital. Nurses carried it out religiously and it worked out well for those patients to be able to have their blood sugar stabilized, and complications prevented. The above practice was still in progress when I left the hospital.

I was in support of that approach because of how effective it was in stabilizing a patient’s blood sugar. Doctors were not called so many times anymore for unstable blood sugar levels. There were no episodes of hypo/hyperglycemia after the EBP approach was initiated. Patients who came for wound care started progressing better, and their wounds were healing well. Despite the fact that the approach showed a phenomenon result, the main barrier that came up was time management. It slowed us down somehow in that sometimes you have to wait for a while before you could see another nurse to witness you at times, and long line pyxis waiting on a busy day, especially in the morning when everyone wants to administer insulin before breakfast.I currently work in an urgent care clinic, and I advocate for EBP in the clinic by mandating that every staff member wash his/her hands after attending to each patient, putting on a mask before attending to any patient, and changing masks in between patients to prevent spreading infections.

4. Evidence-based practice (EBP) is an approach to healthcare that uses the most recent and high-quality research evidence to improve the health and safety of patients while decreasing the overall cost and variations in health outcomes. It is a problem solving approach entailing a combination of the best available research evidence with clinical experience while taking patient needs into consideration (Butts & Rich, 2021). An example of a specific evidence-based practice is the provision of psycho-education to patients with depression in my practice setting. We have noted that medication adherence is a severe problem, and patients who are non-adherent end up developing treatment-resistant depression. Currently, about 30% of patients seeking care in the setting have treatment-resistant depression, which is unacceptably high. We are addressing the problem through the application of psycho-education and motivational interviewing, which have been found effective in improving treatment adherence among patients with depression (González et al., 2022). I have noted that the application of these interventions improves awareness of depression among patients and is an effective approach to decreasing barriers to treatment adherence. The motivation for adherence is also improving as we set treatment goals with patients in line with their individual needs and preferences.

               I would say my organization is friendly when it comes to the adoption of EBP. The management is supportive of quality improvement initiatives seeking to promote EBP. We also have resources such as computers and recent practice guidelines reflects. However, a challenge with EBP in the setting is that the organizational culture is not always supportive. The staff members do not like anything that would increase their workload which makes sustainability of practice change a challenge. Another challenge is the lack of time. The staff are usually busy due to heavy workload, making it a challenge to find adequate time to research and read research reports.

              A systematic review by McArthur et al. (2021) reported that strong leadership support, the presence of EBP champions, and resources, including time, were the main facilitators of EBP. I can advocate for the application of EBP in my setting by becoming a champion for EBP. I would then establish a team of like-minded individuals who are passionate about EBP and advocate for the adoption of EBP. My colleagues would assist in pushing for the sustainability of the new practice, which is a significant problem at my healthcare organization. I would also volunteer to lead training sessions and workshops on EBP to raise awareness. In addition, I would also engage the leadership and request for more staff to address the problem of burnout. Due to staff shortage, time is a major issue, making it hard for the facility to find time for training workshops and seminars. I would also be actively involved in developing policies and procedures in collaboration with other professionals to ascertain that they are grounded in the best research and address patient needs.