Evidence translation and change | Nursing | Chamberlain College of Nursing

 
What are the common barriers to evidence translation in addressing this problem?
     Diabetes is a significant burden in the United States and affects over 34 million people (CDC, 2020). As we continue to learn about this chronic and progressive illness, we have identified the lack of improvement in the management of the disease and the opportunities to close the knowledge gap in nursing practice. Studies have found many reasons contributing to the ability to translate evidence into successful solutions to this problem.  Two key limiters in evidence translation are the patient’s ability for self-management and nursing, and clinician, lack of diabetes knowledge (Alotaibi et al., 2017). Nurses require knowledge to teach diabetic patients and their families about their treatment plan and the risks of poor glucose management. However, many nurses are only skilled at the simple tasks of monitoring glucose levels and point of care treatments. They are often lacking knowledge regarding the underpinning of diabetes in relation to physiology and complication risks (Alotaibi et al., 2017).  Reasons for this include lack of instruction, inconsistent academic preparation, lack of resources in their work environment, and inadequate involvement in providing care to diabetic patients.
What strategies might you adopt to be aware of new evidence?
     In order to address diabetes education and knowledge in the organization, we would evaluate the accuracy of the problem (Tucker, 2017). First, there is the need to understand if there is a gap in our nursing practice of diabetics. This may include evaluating the theoretical understanding of diabetes and the pathophysiology, as well as managing blood glucose levels and reducing complication risks for patients. Various surveys of nurses could be performed to assess the perceived and actual knowledge in these areas. There would also be the need to perform rigorous literature reviews to access new evidence related to diabetes prevalence and treatment options.
     There would also be the need to gain insight as to the education currently provided to diabetic patients in our organization and what changes are necessary for improvement. We would need to include our nurses in this assessment as they bring experience, opinions, and clinical judgement that can contribute to our adoption of new evidence (Tucker, 2017).  
     An evaluation of the organizational culture would be necessary to ensure buy-in by other clinicians if changes are to be implemented. Utilizing interprofessional collaboration to set the foundation for new evidence-based practice can help to motivate the teams to improve patient outcomes while also influencing nurses to be more engaged in their new knowledge in caring for diabetic patients (Tacia et al., 2015).  Ensuring leadership engagement, sharing of values for EBP, and support and resources for frontline nurses will improve adoption of EBP into our practice (Dang & Dearholt, 2018; Tucker, 2016).
How will you determine which evidence to implement?
     Using a framework, such as the PARIHS, will allow us to evaluate the barriers to translating new evidence into our practice by evaluating which evidence is best as well as evaluating the organizational capacity and quality for implementation and change (White et al., 2016).  Evaluating my organizations readiness for change will help to develop the framework for the project and to determine not only if we can successfully change a practice but then to sustain such changes.  
     Next, we will work with key stakeholders and diabetic experts to determine what evidence is necessary to implement. We will use a methodical approach to researching, evaluating, and determining which evidence will improve our nurses’ knowledge of diabetes and which evidence will improve our organizations’ care of diabetic patients. We have learned about clinical practice guidelines (CPGs) as a source of EBP in the care of diabetics (White et al., 2016). 
     We will derive the plan through a systematic approach and allow for input into each step and process.  This will include a questionnaire early in the planning steps to evaluate knowledge and define our practice question.  The next steps will include the review of evidence and determination what is the best evidence to support diabetes education to frontline nurses. There will also be evaluation of the diabetes CPGs. Implementation of learning will be inclusive of online instruction, unit huddles, and diabetes conferences.  After implementation of the education, we will focus on how the nurses translate their new knowledge into practice. We will ensure that technology with our EHR assists the staff in achieving this work without increasing workload and stress.
How will you ensure continuation or sustainability of the change?
     Organizations that support QI, EBP, and research must ensure that they are inclusive of their nurses in such practices. There is the need for leaders, clinicians, and staff to understand the reason for these practices and to live the vision of EBP in their practice (Dang & Dearholt, 2018). In our organization, we have supported nurses while also setting the expectations for EBP by implementing into our strategic imperatives, our Nursing specific goals, and by including frontline nurses in all decisions for change. Our commitment to patient outcomes will ensure that this practice change is well-aligned with our organizational goals.
     Specific communication plans regarding the improvement plan for diabetic education will be provided to all nurses. It will provide the goals for the change, explain the vision for improvement, and explain target audiences that will be included in the project (Dang & Dearholt, 2018).  Staff involvement will be requested, and focus groups will help to share learned information. The education timeline will be clearly defined, and all roles and responsibilities will be shared. The team will have access to resources and there will be interprofessional support with physician partners in this change (Tacia et al., 2015).  We will utilize mentors and informal leaders to help support the teams through positivity and advocacy for their fellow team members (Dang & Dearholt, 2018). Lastly, we will develop a tool for evaluation of our improvement and establish metrics for improvement.  
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