Unit 8 Blog Entry

During rounds, Charles encounters a rare condition he personally has never seen and only vaguely remembers hearing about in nursing school. He takes a few moments to prepare himself by searching the internet. That evening, he researches further to learn how to treat, administer, and assess the patient safely. The sources he researches include online clinical databases and his own school textbooks. Most of the information seems consistent, yet some factors vary. Charles wants to provide the highest quality in patient safety. He wonders which resources are best.

What should Charles do when he encounters direct contradiction in information from two sources?

            When contradiction occurs between two or more sources one must closely evaluate the sources in question.  First he must consider what type of information each of the sources is presenting.  Information on the internet today can come from various sources such as facts, opinions, stories, interpretations, or statistics (Harris, 2015).  It is best in this case to keep to facts or statistics if possible.  Secondly it is important to consider the age of the information, in the health care arena recommendations, guidelines, and facts can change quickly (Harris, 2015).  Lastly one must consider the validity and credibility of  source and is this source free from financial bias on the topic of consideration (HOHcode, 2015). 

Which resources are the most trusted and how to determine this?

            If Charles’s textbooks are not outdated then they could be considered the most trusted sources that he has available.  While books have earned a trusted spot as legitimate sources of information, having been vetted by an entire network of industry specialists, the internet does not have the professional vetting, but it does have the wisdom of the crowds, relying that at least one reader would see an error and point it out in the comments (Johnson,2011).

Which resources are the most accurate and how do your determine this?

            We can assume that the scholarly textbooks have been vetted for accuracy and unless the information is outdated on the subject at hand we are safe trusting the information (Johnson, 2011).  If Charles is dealing with internet information or certain websites the sources can be checked using the Health on the Net Foundation’s website (Healthonthenet.org) which uses HONcode certification to rate the credibility and validity of different sites on the internet.  The health on the net website helps the searcher to maintain ethical standards of information and to use only quality health information in their research (HONcode, 2015). 

What criteria can Charles use to ID credible resources to enhance his clinical practice?

            If you’re visiting a health Web site for the first time, these five quick questions can help you decide whether the site is a helpful resource. (NIH, 2015).

Who? Who runs the Web site? Can you trust them? (NIH, 2015).

What? What does the site say? Do its claims seem too good to be true? (NIH, 2015).

When? When was the information posted or reviewed? Is it up-to-date? (NIH, 2015).

Where? Where did the information come from? Is it based on scientific research? (NIH, 2015).

Why? Why does the site exist? Is it selling something? (NIH, 2015).

If the resources pass the five questions set forth by the NIH, then they can be considered credible resources an may enhance his clinical practice. 

References

Harris, R. (2015).  Evaluating Internet Resources.   Retrieved from: 

http://www.virtualsalt.com/evalu8it.htm

HONcode. (2015).  Retrieved from Health on the net foundation:

            http://www.hon.ch/HONcode/Patients/Visitor/visitor.html

Johnson, H. (2011).  Books vs. Internet: Whose information is more accurate?  Retrieved from:

            http://publishingperspectives.com/2011/10/books-vs-internet-more-

accurate/#.VpLH3IakHug

National Institute of Health (NIH). (2015).   Finding and Evaluating Online Resources on

Complementary Health Approaches.  Retrieved from: 

https://nccih.nih.gov/health/webresources

Unit 7, Blog Entry 2

Unit 7, Blog Entry 2

Identify two ways evidence-based practice is used in your institution. Using the processes described in the article, evaluate how information technology impacts your use of EBP. What are two implications of using technology? How can it be improved?

Two ways evidence-based practice is used in my institution

Our outpatient chemotherapy center uses evidence-based practice in the educational process of our patients on the chemotherapy regimen they are receiving in our care.  Our center utilizes computer based video education on the chemotherapy regimen each and every patient is to receive.   The needs of each individual patient can vary but it has been proven that utilizing computer based teaching with interactive video stimulates the senses of the patient and allows for greater levels of knowledge retention (Lewis, 1999).  

The second way evidence-based practice is utilized in our institution is in the safety practices we use when administrating chemotherapy products to our patients.  Evidence based guidelines are followed with each and every administration of chemotherapy product, this does not vary patient to patient and must be used to protect the safety of the patient and the health care provider (ONS, 2015). 

How Information Technology impacts EBP in the institution

Our computer based interactive video based teaching is directly linked to the institutions intranet.  The Intranet is linked to video servers that yield specific program and videos that are relative to the different chemotherapy agents that we use in the clinic each day.  The touch screen video displays are capable of linking the patient to the internet and many times links are provided and encouraged by the video teaching program. 

The safety guidelines that we utilize in the clinic are also impacted by technology.  Each chemotherapy drug is cross matched with the patient’s current medication list and contraindications and possible reactions are provided for the health care professional to evaluate.   Even the IV pumps are linked into the guidelines of chemotherapy administration through the information system, it is here that the drug, dose, rate, route, and total mix volumes are analyzed and double checked before the administration of the chemotherapy can occur.  We also utilize a two nurse checklist to double check our automated IV smart pumps.  Our clinic also utilizes information technology to go back to the original source of the patient’s pathology report before any treatment can be given.  This is an easy process if the pathology report was generated within the organization, but can become much more complex if it exists outside w

Implications of the technology

The greatest implication of the use of information technology along with our evidence based practice is the increased level of patient safety and satisfaction that we develop.  Another implication is through the information technology the video teaching allows for greater levels of compliance because the patient is more aware of how the therapy will benefit them and the need to stay on schedule with the treatments and evaluations. 

Improvements

As technology increases and our information systems become more advanced it will be possible to achieve even greater rates of intervention by using technology to benefit more aspects of the evidenced based practice.  We can gear our information systems to better interact with the evidence based processes we are using to protect and satisfy our patients.  The more information that is available at the tips of the fingers of the patient the calmer and more relaxed the patient will be with their treatment regimen.

References

Lewis, D. (1999). Computer-based Approaches to Patient Education: A Review of the Literature. Journal

of the American Medical Informatics Association : JAMIA, 6(4), 272–282.

Matter, S. (2006). Empower nurses with evidence-based knowledge. Nursing Management,

37(12), 34–337

Oncology Nursing Society. (2015). Chemotherapy guidelines for administration.  Retrieved from:

                http://www.instituteforquality.org/asco-ons-standards-safe-chemotherapy-administration

Unit 7 Blog Entry 1

Unit 7 Blog Entry 1: Evidence-Based Teaching Strategies

Your organization has finally decided to do away with the antiquated practice of wearing shoe covers in the operating room. Because your hospital has practiced this way for many years, you know there will be resistance to change. You must determine what evidence-based teaching strategies will be best in educating staff on the new practice. Identify three teaching strategies you will use. How will you use them? Identify three or more challenges you expect to encounter when developing your evidence-based teaching strategies. How will you anticipate and overcome these challenges? A thorough method or plan for anticipating and overcoming these challenges should be selected and justified.

Our Health Care Organization has decided to do away with shoe covers in the operating room

Use of shoe covers in critical care area such as the operating room is not helpful in preventing infections of common pathogens such as MRSA and VRE, nor has it decreased the mortality rate among the patients (Ali et al, 2014).  With this new evidence many health care organizations have chosen to do away with the antiquated practice of wearing shoe covers in the operating room.

Evidence-based teaching strategies to best educate staff on new practice

One teaching strategy that will be used to support the evidenced based change of not wearing shoe coverings in the operating room will be peer-to-peer mentoring.  Peer-to-peer mentoring is a constructivist approach to teaching that utilizes social interaction to allow problem solving using a psych cultural approach (Rolloff, 2010).   The second teaching approach to justify the new procedure uses evidence based practice to challenge the practice of using the shoe covers by asking WHY?  If we ask several why questions about the practice it quickly becomes obvious that the practice is not based in fact and lacks evidence to back up the practice (Kaczmared, 2011).  The third approach to educating to support the new practice is Evidence, the searching for supporting facts is an easy way of having the learner teach themselves whether the support for continuing the old practice of wearing shoe covers in the operating ever existed in the first place (Kaczmared, 2011). 

Challenges to anticipate and how to overcome these challenges to the change

One of the greatest resistances to change in an organization occurs simply because the staff becomes comfortable with doing things in one type of manner and they fail to see why the change is needed.  The only way to overcome this resistance it to educate the staff why the change is needed and how everyone involved will benefit from the new change or process (Eisold, 2010).   The second reason change resistance is met within an organization is because the staff members may not fill comfortable using the new approach or method.  This is overcome through instruction of the staff of the upcoming change early in the process, thus allowing the staff members to gain confidence in their ability to utilize the change and make it effective (Eisold, 2010).  Lastly resistance to change comes from fear and resentment that the change is being implemented.  Management must be supportive of the staff and listen to their concerns, it is important to incorporate the needs of the staff into the change process if possible (Eisold, 2010). 

Implementation Method

Before any mention of change is made it is important to get the input of the staff on the general matter.  It is easier to get the staff to admit a change needs to be made if they feel a part of the process (Eisold, 2010).   A complete evaluation of the original process is needed, in this case why are the shoe coverings being worn in the first place (Kaczmarek, 2011).  The need for change must be identified and then the benefits from the change must be factored.  After the staff is trained and informed of why the change is being made, then the implementation of the change can happen.  Evaluation of the change and the resistance to it needs to be evaluated until it is apparent that the new policy is working and is beneficial to all parties involved in the change.

References

Ali Z, Qadeer A, Akhtar A. To determine the effect of wearing shoe covers by medical staff and visitors

on infection rates, mortality and length of stay in Intensive Care Unit. Pakistan Journal of

Medical Sciences. 2014;30(2):272-275.

Eisold, K. (2010).  Resistance to change in organizations.  Retrieved from:

https://www.psychologytoday.com/blog/hidden-motives/201005/resistance-change-in-organizations

Kaczmarek, D. (2011). Herding, putting to pasture those sacred cows. Healthcare Purchasing News,

35(3), 72–73.

Rolloff, M. (2010). A constructivist model for teaching evidence-based Practice. Nursing Education

Perspectives, 31(5), 290–293.