Evidence Based Practice Presentation

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timer Asked: Mar 6th, 2018
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Question Description

Details:

Develop a PPT presentation no longer than 10-12 slides with comprehensive speaker's notes that covers all of the major areas of your proposal.

You will need to post your Evidence-Based Practice Presentation to the main forum in Topic 8 as directed by the instructor for class discussion and peer feedback.

While APA format is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are not required to submit this assignment to Turnitin.

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GET UP AND GO HOME 1 Get Up and Go Home Julie Braylock Grand Canyon University: NUR:699 March 7, 2018 Professor Cindy Boyle GET UP AND GO HOME 2 TABLE OF CONTENTS Section Page ACKNOWLEDGMENTS ..................................................................................................iii TABLE OF CONTENTS ................................................................................................... iv ABSTRACT ........................................................................................................................ v SECTIONS 1. Introduction ................................................................................................. 1 2. Review of Literature and Synthesis of the Evidence ................................... 3 3. Plan for Implementation ............................................................................ 18 4. Plan for Evaluation .................................................................................... 28 5. Conclusions, Recommendations and Implications .................................... 36 REFERENCES .................................................................................................................. 38 APPENDICES APPENDIX A – Progressive Mobility Continuum ........................................................... 43 LIST OF TABLES Table Page Table 1 Summary of Reviewed Evidence......................................................................... 10 Table 2 Estimated Timetable Blueprint for Implementation ............................................ 26 Table 3 EBP Evaluation Plan ........................................................................................... 33 GET UP AND GO HOME 3 Abstract An abstract is a brief, comprehensive summary of the contents of a paper (American Psychological Association, 2010) that runs a maximum of 120 words. It should contain a synopsis of the points in the paper, but also be readable and well organized. To use this page of the template, simply delete this paragraph and start typing. The formatting should stay the same. GET UP AND GO HOME 4 Spring Valley Hospital was established in 2003 as the first acute care hospital in Southern Nevada in Las Vegas. The hospital has recorded outrageous growth regarding community that they provide their services. Currently, the hospital has a bed capacity of 292. The services that are offered are inclusive of emergency services offered in 24 hours, maternity services, inpatient and outpatient rehabilitation, wound care and cardiovascular services. An evidence-based practice readiness survey was conducted. The mission of the hospital is to “provide a culture of excellence with committed employees, physicians, and volunteer deliver safe quality patient care for their community” (Spring Valley Hospital 2018). Working at Spring Valley for several years, it is evident that the hospital is striving to provide optimal care to the patients which includes best practice guidelines to insure the best possible patient outcomes. Knowing this, the facility was scored facility a 5 for this category. The organization's level of readiness lies in interprofessional collaboration. The hospital is part of six acute care hospitals that are responsible for providing patient care within Southern Nevada and Las Vegas at large. The other hospitals that take part include Desert Springs Hospital Medical Center, Summerlin Hospital Medical Center, Valley Hospital Medical Center, Henderson Hospital and Centennial Hills Hospital Medical Center (Spring Valley Hospital Medical Center, 2018). Interprofessional collaboration is essential since it improves the outcome of patients. Additionally, teamwork is vital in reducing workload and thus improves job satisfaction for both the healthcare workers and the patients (Bosch & Mansell, 2015). As an employee at the facility, it was noted that when the workers were relieved of workload and this increased work efficiency. The program also helped in interprofessional-based education among the workers in the hospital. GET UP AND GO HOME 5 The hospital is not a Magnet Hospital but does have some evidence-based practice (EBP) guidelines in effect. Nurses are educated and responsible to adhere to the guidelines daily. The hospital did score a 5 because the most recent EBP guidelines are put into practice. The hospital scored a 3 for the degree in which nursing staff is dedicated to EBP. This score the fact that the staff does fall short in committing to guidelines. Some of the barriers does tie in with lack of education. The hospital also offers minimal training opportunities to nurses. The facility scored a 3 in this area. Training is crucial since it improves skills and knowledge. Through training, nurses can improve their basic understanding and thus become more robust when faced with challenges in their daily activities. The hospital use of electronic health records requires people who are trained. The electronic records make the work easy as the files are easy to find and thus time conscious. The hospital has fewer staff members than the required number. However, to curb this issue, the hospital allows volunteers who fill the gap to ensure that workload is minimized, and the patients stay in the hospital is reduced. This is mainly because of the training that is offered to ensure that the serviced offered are of good quality and up-to-date. Evidencebased practiced (EBP) in nursing at Spring Valley Hospital is apparent. EBP aims to make available valuable and practical care to the patients with the intent to improve the outcome. The hospital fulfills this by ensuring that the EBP in nursing is practiced (Spring Valley Hospital Medical Center, 2018). The patients who were admitted to the hospital give feedback stating that they received the most effective care based on available facts. Possible project barriers for EBP in the hospital include misunderstanding of the statistics, scarce time to carry out the EBP and to read the literature and lack of power to change the care given to the patients. Barrier facilitators include support from peers and colleagues as well as managerial support. Insufficient authority to prompt a change in the practice setting has GET UP AND GO HOME 6 been a major barrier in the hospital. The organization should be willing to support the implementation of research in the six facilities that are within the Valley system. Lack of time to implement and review the findings was also another barrier in the hospital. I scored the facility at a 4 in this area. There are less training opportunities and support policies that are in the hospital, and this makes it hard for the hospital to promote EBP at regular intervals. Promoting clinical inquiry and generating an interest in EBP is significant in a hospital setup. This is because they facilitate positive outcomes such as build of interdisciplinary relationships, creating rapport and generating a continuing trustworthy structure. One of the methods to improve clinical inquiry is through coaching and mentorship of the steps involved in EBP. Another method is to change the authority among the nurses to provide a platform to ask what is not understood. Moreover, encourage the nurses to identify patients who are interested in taking part in the EBP. Problem Statement According to (Truong et al, 2009) “In the Intensive Care Unit, critically ill mechanically ventilated patients have been considered too ill to move leaving them to traditional bed rest to which can lead to detrimental effects on the patients physical, emotional, and social health. ICU acquired weakness (ICU-AW) is an accumulative effect of prolonged bed rest, malnutrition, and systemic inflammation”. The author goes on to explain that “Once a patient has been compromised by ICU-AW, the patient may experience prolonged mechanical ventilation, prolonged hospitalization due to secondary diagnoses from hospital acquired injuries (HAIs), muscle wasting requiring ECF placement, and decreased quality of life due to prolonged effects of immobility” (Truong et al 2009). The general weakness of the muscles develops in patients GET UP AND GO HOME 7 admitted in the ICU due to acute illness or treatment of the disease. The loss of muscle mass and muscle strength in patients in the ICU was first recorded in the nineteenth century (Hermans & Berghe, 2015). The main complications related to ICU-AW are critical illness polyneuropathy and critical illness myopathy. The incidence rate of ICU-AW is reported to be 25% to 100% (Zororwitz, 2016). It is a frequent complication of a critical illness which is linked to high morbidity and mortality rates. Additionally, the condition has long-term consequences in patients who are discharged from the hospital for an instance post-intensive care syndrome which comprise of mental, physical and cognitive dysfunction. ICU-AW is associated with multiple dysfunctions of organs, and thus patients have activity limitations. These patients require physical assistance mostly from the nurses to perform even the most basic activities related to bed movement. The purpose of this paper is to provide a proposed evidence-based project whose aim is to reduce the effects of ICU-AW and decrease hospitalization duration for patients with mechanical intubation in Spring Valley Hospital. The proposed problem is an issue not only in the US but a globally. Patients in ICU are at a higher risk of losing muscle mass and mass strength due to reduced physical inactivity and increased metabolism. Additionally, decreased pathophysiological mechanisms which include metabolic, microvascular, electrical and bioenergetic adaptation give rise to muscle atrophy and reduced muscle mass and strength (Zhou et al, 2014). From the proposed problem, researching Spring Valley Hospital would be of great importance as there would be an evidence-based project that will be used in the field of nursing. Moreover, the hospital will receive a good reputation. Weaning off mechanical ventilation is related to problems of the diaphragm, intercostals muscles, phrenic nerves and other accessory respiratory muscles. In rare cases, facial muscles may be affected, and thus paralysis of the muscles surrounding the eye may occur. The GET UP AND GO HOME 8 research will benefit patients who are in the ICU all over the world as well as nurses. EBP in the hospital will only be possible if there is collaboration among hospital workers and support from peers and colleagues as well as managerial support. When conducting this research, it is essential to develop a PICOT statement to enable useful interview due to this epidemic. The question could be: In critically ill mechanically ventilated patients (P), does the implementation of early mobility to reduce the risk of ICU acquired weakness (ICU-AW) (I) compared to use of complete bed rest (C) decrease hospital stay (O) over time (T)? The purpose of conducting this research is to find out practical interventions that will facilitate reduction of the effects of ICU-AW and aid in the reduction of hospital stay for patients with mechanical intubation. This will, therefore, reduce morbidity and mortality rate in the US as well as reduce the long-term complications for patients who are discharged. The EBP is essential in the field of nursing as it provides practical care for patients with similar conditions with the intention of improving the outcome of the patients. Evaluation of the Evidence Immobility in the ICU is a contributing factor to an increased hospital stay, complications upon discharge, and physical deconditioning. Even though early mobility has shown great improvements in ICU patients, research shows that there is lack of necessary resources that would significantly lead to the implementation of early mobility. It is a frequent complication of a critical illness which is linked to high morbidity and mortality rates. Additionally, the condition has long-term consequences in patients who are discharged from the hospital for an instance post-intensive care syndrome which comprise of mental, physical and cognitive dysfunction. ICU-AW is associated with multiple dysfunctions of organs and thus patients have activity GET UP AND GO HOME 9 limitations. Risks factors associated with bed rest include poor response to stress responses for patients with muscle wasting and immobility. Early mobilization seeks to decrease the effects of ICU-AW and decrease hospitalization duration for patients in ICU. There was an initiative carried out by 13 ICUs in eight hospitals in the US which aimed at integrating the most recent evidence on the practice of mobility into the modern ICU culture (Bassett, Vollman, Brandwene, & Murray, 2012). This was done through designing and implementing evidence-based mobility continuum that was physiologically grounded and friendly to its users. Targeted messages and appropriate education was given to the stakeholders and change interventions were given to the staffs to modify their behaviors in their field of practice for it to be long term. Another study was carried out that involved 106 patients. The inclusion criteria of the study were patients had to be in ICU, the APACHE II score should not be below 14.7. The duration of the research was four weeks. The outcome measures used were number of days that the patient was mobilized, reasons why the patients were not mobilized and adverse events that took place during the search (Leditschke, Green, Irvine, Bissett, & Mitchell, 2012). Early mobilization therapy has been closely linked to improved survival in critically ill and mechanically ventilated patients. Prolonged lack of mobility and total bed rest increases catabolism and muscle wasting. These are the major reasons why patients in ICU have neuropathy and ICU-AW (Lipshutz & Gropper, 2013). Various equipment and expertise exist to ensure that there is compliance with early mobilization programs. Research and EBP should be conducted to find out the drugs that will reduce muscle atrophy for patients in ICU. Collection of qualitative data was used to evaluate issues that surround mobility as well as providing feedback to the stakeholders who were expected to support the change. Early GET UP AND GO HOME 10 mobilization is associated with reduced skin injuries, reduced longevity of hospital stays, improved ventilation-free days, decreased hallucinations and reduced cases of complications after discharge. The validity of the research was not correct since this study had fewer participants and a short period of time (Bassett, Vollman, Brandwene, & Murray, 2012). Analysis of benefits, safety, and feasibility of early mobility on critically ill patients compared to traditional bed rest. It had 10 studies with 868 participants. The study involved two prospective studies and two observational studies. From the reviews, the study showed that mobilization can be directed to the patients as to the patients as per their level of tolerance to the activity (Schweickert, et al., 2009). It thus promoted safety and positive effects of the therapy. There was also reduced the number of free ventilation. Presence of family was shown to be a motivational factor and beneficial in early mobilization. Engaging of the family together with the patients serve as a standard of care but in ICU, this is not allowed. The research was done to identify the role that the family plays to help in the recovery of the patients. This is beneficial for both the patients and the staff since workload for the staff is significantly lessened (Rukstele & Gagnon, 2013). Active presence, protection, facilitation, history, coaching, and volunteering of caregivers is important. From the randomized control trials, it is evident that early mobilization of ICU patients is important as it helps in reducing hospital stay, reduces complications after discharge, reduced muscle atrophy and ICU-AW (Vollman, 2013). These studies, however, did not address adverse effects of immobility such as increased hallucinations, atelectasis, and skin injuries. However, there was improved muscle tone. Implementations of measures that reduce sedation and improve mobility are therefore important. This will significantly reduce the mortality rate associated with ICU acquired weakness. These trials provide techniques that are used to evaluate and implement GET UP AND GO HOME 11 treatments using evidence-based practices for patients in the ICU to provide the progressive guidelines that should be used in search cases. Insert PICO Question--"For mechanically intubated patients does the implementation of early mobility decrease the length of hospitalization compared to traditional bed rest?" Insert Keywords-- Early mobility, mobilization, intensive care acquired weakness, intensive care, and mechanical ventilation. Insert Databases Searched—CINHAL, JBI Connect+, PubMed, Science Direct, PROQUEST, Cochrane Library, Google Scholar Authors/Year of Citation Amidei, C. (2012). Measurement of physiologic responses to mobilization in critically ill adults. Intensive and Critical Care Nursing, (28), 5872. Research Design Sample: N= 567 Adults > 239 patients mechanically ventilated. Data Collection Methods Vital signs monitored pre, post, and during intervention include heart 5 out of 12 rate, blood studies RCT pressure, setting: ICU Respiratory setting, post rate, Sa02, ICU setting SV02, C02 and production, community IL-6 & IL-10 setting inflammation markers, Borg Design/Metho rating of d: Systematic perceived Review: exertion twelve articles surveys, and were retrieved muscle from strength electronic measurement databases, tests, (MMT) from 1990manual 2011, Key Findings Characteristics All the studies included in the systemic review assessed physiologic responses to mobilization on critically ill patients. The SR explained in depth to what extend that all the noted evaluation tools may be performed and how the reliability of each evaluation tool may be altered by Strengths: There was a mixture of studies presented and evaluated. identified cytokine as the only evaluation variable that is a safety measure and a desired outcome. Weaknesses: No evaluation for measurements was focused on comfort or sleep related to mobilization or length of hospitalization GET UP AND GO HOME Bassett, R., Vollman, K., Brandwene, L., & Murray, T. (2012). Integrating a multidisciplinary mobility program into intensive care practice (IMMPTP): A multicenter collaborative. Intensive and Critical Care Nursing, (28), 88-97. doi: 10.1016/j.iccn.2011.12. 001 12 including CINAHL, MEDLINE, PubMed, and Cochrane Database of Systematic Reviews. muscle testing, (MRC) medical research council muscle strength grading scale, and PFT’s for respiratory muscle strength. medications, techniques, performance by technicians, or the patients understanding of the surveys. The SR also stressed on the patient safety before evaluation of efficacy. Despite each measurement tool having the ability to be inaccurate to some extent, it is the collaboration of multiple measurement tools to evaluate an accurate assessment of mobility on a critically ill patient. address in this review. Sample: N=130 nonspecific ICU patients 10 from each facility studied over a 30-day period Qualitative surveys from team members on culture of change Quantitative results from retrospective chart abstractions and concurrent direct observational data Monthly conference The literature review suggest that early mobilization has been shown to decrease VAP, skin injuries, length of hospital stay, decreased delirium and improve the amount of ventilator free days as well as Strengths: This study addresses the critical illness of patients while giving an algorithm like protocol to follow for severity of illness and amount of PT the patient can follow. It addresses the culture to which S ...
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Attached.

Evidence Based Practice Presentation
Name

Institution
Date

Introduction


Spring Valley Hospital was established in 2003 as the first acute care hospital in
Southern Nevada in Las Vegas.



The services that are offered are inclusive of emergency services offered in 24 hours,
maternity services, inpatient and outpatient rehabilitation, wound care and
cardiovascular services.



The mission of the hospital is to “provide a culture of excellence with committed
employees, physicians, and volunteer deliver safe quality patient care for their
community.”



The hospital is striving to provide optimal care to the patients which includes best
practice guidelines to insure the best possible patient outcomes.

Research problem


In the ICU, critically ill mechanically ventilated patients have been considered too ill to
move leaving them to traditional bed rest to which can lead to detrimental effects on the

patients physical, emotional, and social health.


ICU-AW is an accumulative effect of prolonged bed rest, malnutrition, and systemic
inflammation”.



Patients in ICU are at a higher risk of losing muscle mass and mass strength due to
reduced physical inactivity and increased metabolism.



Additionally, decreased pathophysiological mechanisms give rise to muscle atrophy and
reduced muscle mass and strength.



Researching Spring Valley Hospital would be of great importance as there would be an

evidence-based project that will be used in the field of nursing.

PICOT statement


In this research, it is essential to develop a PICOT statement to enable useful interview
due to this epidemic.



The question could be: In critically ill mechanically ventilated patients (P), does the
implementation of early mobility to reduce the risk of ICU acquired weakness (ICUAW) (I) compared to use of complete bed rest (C) decrease hospital stay (O) over time
(T)?



The purpose of...

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