week 7 DQ response

Enhancing the Sustainability of EBP Initiatives

Su Chang posted Apr 16, 2020 10:28 AM

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Evidence-based practice (EBP) integrates the scientifically proven evidence to guide nursing care and improve patient outcomes. Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values (Melnyk, Fineout-Overholt, Stillwell, & Williamson, 2010).
Ventilator-associated pneumonia (VAP) following cardiac surgery is a preventable complication associated with outcomes, and there are many standardized guidelines by EBP to prevent VAP. The EBP is implemented to prevent VAP following cardiac surgery at XYZ hospital by cardiothoracic nurse practitioner team (CTNP), which is a nurse-led early extubation protocol. This protocol starts with the pre-operative cardiac education. The CTNP informs the patient and families that the patient will be on a ventilator after surgery so that the patient would be aware of the ventilator weaning procedure. An EBP research by Ertürk & Ünlü’s (2018) shows that the primary sources of pre-operative anxiety were lack of knowledge, and pre-operative individualized education could reduce postoperative pain and anxiety level. Providing proper pre-operative education decreases the need for sedative while the patient is on a mechanical ventilator (Ertürk & Ünlü, 2018). The less need for sedative leads to early extubation, which is one of the ways to prevent VAP.
The goal of early extubation in the XYZ hospital is within six hours after cardiac surgery. An RN or respiratory therapist need to document the time when the patient arrived in ICU and when extubated. This record is a measurement for our early extubation protocol on post-cardiac surgery patients. If the patient were not able to be extubated in six hours, RN and NP would look into the cause of why the patient needed to be on a ventilator longer. Then cardiothoracic nurse practitioner collects these data and utilizes to make better cardiac education program and protocol.
Kotter and Cohen’s Model of Change is an excellent way to implement or sustain EBP in nursing practice since this model emphasizes commination and empowerment. Evidence from Kotter and Cohen’s work with facilities to change the behavior of professionals has indicated that a leader must communicate their vision and make their points to empower the professionals (Melnyk, B. M., & Fineout-Overholt, 2019, p. 434). As advanced practice nurses (APN), they should collaborate with other healthcare providers to improve nursing practice. For this collaboration, the APN should communicate with nurses and empower them to adopt and utilize EBP into nursing practice.

References
Ertürk, E. B & Ünlü, H. (2018). Effects of pre-operative individualized education on anxiety
and pain severity in patients following open-heart surgery. International Journal
of Health Sciences. 12 (4), p 26-36.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M., (2010). Evidence-
based practice: Step by step: The seven steps of evidence-based practice, The American
Journal of Nursing,110 (1), p. 51-53. doi: 10.1097/01.NAJ.0000366056.06605.d2
Melnyk, B. M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing and
healthcare: A guide to best practice. Philadelphia: Wolters Kluwer.

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