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NU300M3: Competency Assessment Evidence-Based Practice: Innovation and Change Worksheet Introduction Many innovations in healthcare offer the promise of improved patient outcomes. Healthcare innovations can be prompted by nursing research that provides new supporting evidence for practice. Evidence-based practice innovations require a vision for what is possible and a willingness to embrace change. Directions Complete Parts A, B, and C on the following worksheet. All responses should be written in complete sentences. Provide a citation and reference for any supporting resource utilized. Part A: Current Applications of Nursing Research 1. Review the research studies designated in the Course Resources. 2. Choose one (1) study to discuss in the box below. · Describe the issue/problem addressed in this study and its significance. · Which research approach method was utilized to study this topic? · See pp. 196 - 197 of your textbook (Blais & Hayes, 2016). · Explain how the findings from this study can improve patient outcomes. · APA in text citation and reference are required. Problem and Significance Research Approach Method Improving Patient Outcomes Part B: Future Applications of Evidence-Based Practice 1. Reflect on problems you have observed in the healthcare setting that have a direct effect on patient outcomes. Think about how some of these problems could be addressed through new/original nursing research. 2. Choose one (1) such problem to discuss in the box below. · Describe the problem and its significance. · Explain how new/original nursing research might be used to address this problem and improve patient outcomes. · Which research approach method should be utilized to study this problem? Why? See pp. 196 - 197 of your textbook (Blais & Hayes, 2016). Problem and Significance Addressing the Problem: Improving Outcomes Research Approach Method Part C: Navigating Change 1. The implementation of any innovation in evidence-based practice requires change. Reflect on your experiences with practice changes in the healthcare setting. Think about the people and processes that were involved in the change. 2. Choose two (2) common/motivating forces associated with practice changes you have experienced in the healthcare setting. See p. 290 of your textbook (Blais & Hayes, 2016). · Describe the motivating force. · Give an example of how the motivating force manifested itself in the healthcare setting. · How did the motivating force facilitate or accelerate the implementation of new practices in the healthcare setting? Motivating Force #1: Description, Example, Effect Motivating Force #2: Description, Example, Effect 3. Choose two (2) restraining forces associated with practice changes you have experienced in the healthcare setting. See p. 290 of your textbook (Blais & Hayes, 2016). · Describe the restraining force. · Give an example of how the restraining force manifested itself in the healthcare setting. · How did the restraining force impede or block the implementation of practice changes in the healthcare setting? Restraining Force #1: Description, Example, Effect Restraining Force #2: Description, Example, Effect References: Page 4 of 4 Page 1 of 2 NU300 M3 : Competency Assessment Evidence - Based Practice: Innovation and Change Worksheet Introduction Many innovations in healthcare offer the promise of improved patient outcomes. Healthcare i nnovation s can be prompted by nursing research that provides new supporting evidence for practice . E vidence - based practice innovations require a vision for what is p ossible and a willingness to embrace change. Directions Complete Parts A, B, and C on the following worksheet . All responses should be written in complete sentences. Provide a citation and reference for any supporting resource utilized. Part A: Current Applications of Nursing Research 1. Re view the research studies designated in the Course Resources . 2. Choose one ( 1 ) study to discuss in the box below. · Describe the issue/ problem addressed in this study and its significance . · Which research approach method was utilized to study this topic? o See pp. 196 - 197 of your textbook (Blais & Hayes, 2016). · Explain how the findings from this study can improve patient outcomes. · APA in text citation and reference are required. Problem and Significance Research Approach Method Improving Patient Outcomes Page 1 of 2 NU300M3: Competency Assessment Evidence-Based Practice: Innovation and Change Worksheet Introduction Many innovations in healthcare offer the promise of improved patient outcomes. Healthcare innovations can be prompted by nursing research that provides new supporting evidence for practice. Evidence-based practice innovations require a vision for what is possible and a willingness to embrace change. Directions Complete Parts A, B, and C on the following worksheet. All responses should be written in complete sentences. Provide a citation and reference for any supporting resource utilized. Part A: Current Applications of Nursing Research 1. Review the research studies designated in the Course Resources. 2. Choose one (1) study to discuss in the box below. Describe the issue/problem addressed in this study and its significance. Which research approach method was utilized to study this topic? o See pp. 196 - 197 of your textbook (Blais & Hayes, 2016). Explain how the findings from this study can improve patient outcomes. APA in text citation and reference are required. Problem and Significance Research Approach Method Improving Patient Outcomes Learning about Turning: Report o f a Mailed Survey o f Nurses' Work to Reposition Patients Debra R. Hanna, Ann Marie Paraszczuk, Margaret M. Duffy, Lawrence A. DiFiore Repositioning a patient every 2 hours remains the gold standard of nursing care to prevent pressure ulcers. Findings from this study showed silent factors are clinical realities that can increase nurses' work to reposition patients. Silent factors also can affect how nurs es prioritize their work. R epositioning patients every 2 hours to prevent pressure ulcers became the gold stan dard of nursing care in an era when the nation's healthcare system was very different: the 1950s-1980s (Lyder, 2002). In contrast, current acute care patients live longer, are more physiologically frail, weigh more, and often have several coexist ing conditions. These patients thus have more risk for developing pres sure ulcers than patients in the past. In 2008, hospital-acquired pres sure ulcers (HAPUs) were placed on the list of never events by the Centers for Medicare & Medicaid Services (CMS). According to Wat son (2010), the list of never events contained 28 items in six different categories. Stage 3 and Stage 4 HAPUs were listed as care manage ment events. CMS will not pay any costs associated with patient care that results from never events. The main effect of this policy on clinical nurses has been the burden they feel to ensure patients do not sus tain HAPUs. However, it is unclear if staffing levels or nurses' work processes have been redesigned suitably to meet increased patient care demands (Myny et al., 2012). With contemporary mattresses now able to reduce pressure effec tively, the need to maintain the tra ditional standard for repositioning patients has been questioned. Yet, repositioning a patient every 2 hours remains the gold standard of nursing care to prevent pressure ulcers (Makic, Rauen, Watson, & Poteet, 2014). Significance of Research In preparation for this study, 15- year trends from 1993-2008 for cer tain patient conditions were exam ined in 2010 using the public access path to the Health Care Utilization Project database (HCUPnet). This analysis established trends of increased cases for morbid obesity, mechanical ventilation, and Clostri dium difficile (C. difficile), examined with z-statistic testing (significant at p=0.00000). Between 1993 and 2008, cases of morbid obesity increased 29-fold, mechanical ven tilation cases nearly doubled, cases of C. difficile increased four-fold, and fecal incontinence tripled. These findings were used to develop the investigator-designed survey booklet. Findings also supported the pre-study hypothesis that nurs es' work related to repositioning patients to prevent pressure ulcers might have increased in ways that are unrecognized within staffing models. Debra R. Hanna, PhD, RN, is Associate Professor, Division of Nursing, Molloy College, Rockville Centre, NY. Ann Marie Paraszczuk, EdD, RN, is Associate Professor, Division of Nursing, Molloy College, Rockville Centre, NY. Margaret M. Duffy, PhD, RN, is Senior Administrative Director, Northwell Health, Manhasset, NY. Lawrence A. DiFiore, PhD, is Assistant Professor, Department of Mathematics, Molloy College, Rockville Centre, NY. Acknowledgments: The authors thank Jacqueline Dienemann, PhD, RN, FAAN, NEA-BC, Professor Emeritus, School of Nursing, UNC Charlotte, who provided valuable feedback for writ ing the research grant proposals; Paul Puccio, New York State Nurses Association, for assisting with the first random sample; and nurses from NYSNA who responded to the survey; Academy of Medical-Surgical Nurses for providing access to their list of nurses and AMSN nurses who responded to the survey. The authors also thank the graduate research assistants who were assigned by Molloy College to assist during this study: Denise Dilena (Fall, 2012); Claudia Mayorga (Summer, 2013); Susana Chavez (2013-2015). Note: This study was funded with two Molloy College Faculty Scholarship grants and with a research grant from the principal investigator’s alumni association, the original Columbia University-Presbyterian Hospital School of Nursing Alumni Association, Inc. MEDSURG nursxno July-August 2016 • Vol. 25/No. 4 219 Research for Practice Purpose The purpose of the current study was to examine nurses' work and work environments in relation to repositioning patients to prevent pressure ulcers. The study examined four previously unrecognized