Evidence-Based Practice Change Process
Download the EBP Change Process form (Links to an external site.) during Week 1. The use of this specific form is REQUIRED
Identify a clinical topic and related nursing practice issue you think needs to be changed.
Locate a systematic review on your topic from the CCN Library databases. Be sure this involves nursing actions.
Work through each step of the ACE Star Model as outlined on the assignment form (Star Points 1-5: Discovery, Summary, Translation, Implementation, and Evaluation). Respond to the instructions provided on the form.
Follow the activities and thinking of Nurse Daniel in Weeks 1-6 in the ‘Illustration’ part of each lesson. He will be working through a clinical topic and nursing practice issue to demonstrate a change (ACE Star Model and systematic review).
Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.
Please cite any references (in APA format) of your systematic review or other scholarly document (optional) as needed.
Paraphrasing information, rather than quoting, is expected. No quotes for this assignment please!
Week 6 Assignment: EBP Change Process form
ACE Star Model of Knowledge Transformation
Follow Nurse Daniel as your process mentor in the weekly Illustration section of the lesson. Please do not use any of the Nurse Daniel information for your own topic, nursing intervention, or change project. Nurse Daniel serves as an example only to illustrate the change process.
Star Point 1: Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)
Topic: pain mismanagement in palliative care settings
Nursing issue: Nurses’ awareness and understanding of patients’ pain
Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.
Providing comfort is the main purpose of palliative care departments. Hence, when nurses are ill-equipped to recognize and manage the pain, the facility fails to meet its primary objective. Therefore, the evidence-based intervention will work toward enhancing pain management outcomes within the facility through easily accessible resources.
Star Point 2: Summary (Evidence to support need for a change)
Describe the practice problem in your own words and formulate your PICOT question.
Pain mismanagement mainly occurs when the caregivers lack a keen understanding of the causes and intensity of pain that patients experience. Hence, pain assessment is a crucial step in providing adequate pain management. However, many patients in palliative care may not have reliable communication due to conditions like dementia. Nurses must decide if the patients’ pain report is accurate or not. Hence, the EBP project will center around the PICOT question:
Among palliative care patients with limited communication capacity (P), is the use of nurse-based pain assessment (I) more effective than pain self-reporting (C) in reducing physical, psychological, and spiritual suffering (O) for the patient’s admission period (T)?
List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected.
Pinheiro, A., & Marques, R. (2019). Behavioral Pain Scale and Critical Care Pain Observation Tool for pain evaluation in orotracheally tubed critical patients. A systematic review of the literature. Rev Bras Ter Intensiva, 31(4), 571–581. https://doi.org/10.5935/0103-507X.20190070
List and briefly describe other sources used for data and information. List any other optional scholarly source used as a supplement to the systematic review in APA format.
Barzanji, A., Zareiyan, A., Nezamzadeh, M., & Mazhari, M. S. (2019). Evaluation of Observational and Behavioural Pain Assessment Tools in Nonverbal Intubated Critically Adult Patients after Open-Heart Surgery: A Systematic Review. Open Access Macedonian Journal of Medical Sciences, 7(3), 446–457. https://doi.org/10.3889/oamjms.2019.103
Deldar, K., Froutan, R., & Ebadi, A. (2018). Challenges faced by nurses in using pain assessment scale in patients unable to communicate: a qualitative study. BMC Nursing, 17, 11. https://doi.org/10.1186/s12912-018-0281-3
Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.
The study aimed to assess the relevance of two nurse-observed pain assessment tools: the Behavioral Pain Scale and the Critical Care Pain Observation Tool. The researchers focused on using the tools on orotracheally-intubated patients. Thus, they could not express themselves. They found that both tools were reliable and valid with acceptable psychometric capacities. The review incorporated 15 studies from diverse cultural and clinical settings, making the evidence strong.
Outline one or two evidence-based solutions you will consider for the trial project.
The evidence-based solution will entail training nurses to use nurse-based pain assessment tools (including behavioral and observational) to enhance their competency in evaluating pain when patients cannot speak.
Star Point 3: Translation (Action Plan)
Identify care standards, practice guidelines, or protocols that may be in place to support your intervention planning (These may come from your organization or from the other sources listed in your Summary section in Star Point 2).
Care standards: Language competency among nurses, ability to determine when the nurse-based pain assessment tools are appropriate
Practice guidelines/protocols: timely pain assessment, accurate recording, and reporting of results
List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).
The nurse leader- will organize the teams to engage in the practice
Nurses (including myself) – will participate in the EBP-process and adopt the new measures in pain assessment
Facility administration- provide external resources, e.g., trainers to educate the care team, fund the EBP process
What specifically is your nursing role in the change process? Other nursing roles?
Beyond embracing the new EBP practices, the nurse must also report any patient-specific challenges in using it. Thus, they will allow the refinement of the project to optimize patient outcomes.
List your stakeholders by position titles (charge nurse, pharmacist, etc.). Why are the members chosen (stakeholders) important to your project?
Charge nurse- will organize and spearhead the entire project
The hospital clerk – will ensure that the nurses have the appropriate evaluation tools in their work-designate digital mobile devices.
The physician- will approve the use of the pain assessment tools and develop a care plan for different scores.
What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?
An adequate analysis will consider the financial expense and the lost working hours in training as the major costs. On the other hand, the analysis must incorporate the financial gain due to patient satisfaction, reduced litigation based on missed care, and the streamlining of the pain management process as the benefits. Hence, the charge nurse, facility administration, and accountants must weigh these items to determine the project’s relative benefit.