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Evidence-Based Practice Change Process
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).
Work on a portion of the process each week, as the illustration unfolds.
Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing practice issue.)
Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.
Star Point 2: Summary (Evidence to support need for a change)
Describe the practice problem in your own words and formulate your PICOT question.
List the systematic review chosen from the CCN Library databases. Type the complete APA reference for the systematic review selected.
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.
Briefly summarize the main findings (in your own words) from the systematic review and the strength of the evidence.
Outline one or two evidence-based solutions you will consider for the trial project.
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).
List your stakeholders (by title and not names; include yourself) and describe their roles and responsibilities in the change process (no more than 5).
What specifically is your nursing role in the change process? Other nursing roles?
List your stakeholders by position titles (charge nurse, pharmacist, etc.). Why are the members chosen (stakeholders) important to your project?
What type of cost analysis will be needed prior to a trial? Who needs to be involved with this?
Star Point 4: (Implementation)
Describe the process for gaining permission to plan and begin a trial. Is there a specific group, committee, or nurse leader involved?
Describe the plan for educating the staff about the change process trial and how they will be impacted or asked to participate.
Outline the implementation timeline for the change process (start time/end time, what steps are to occur along the timeline).
List the measurable outcomes based on the PICOT. How will these be measured?
What forms, if any, might be used for recording purposes during the pilot change process. Describe.
What resources are available to staff (include yourself) during the change pilot?
Will there be meetings of certain stakeholders throughout the trial? If so, who and when will they meet?
Star Point 5: (Evaluation)
How will you report the outcomes of the trial?
What would be the next steps for the use of the change process information?
(Please choose your own topic, any good topic)Examples like medication errors etc.
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Evidence-Based Practice Change Process
Star point 1: Discovery
The topic selected for discussion is Medication of children in emergency department of a health care facility. The nursing practice “Pain Management for young children in Neonatal care”.
Rationale and scope of the issue chosen
Nurses are solely responsible for admission and providing healthcare services for infants and young children who may still not be familiar with a healthcare environment. When a child is born, blood samples are drawn to determine a number of health factors like blood group and others. Similarly, they are scheduled for numerous vaccination programs. These processes involve piercing of the skin with a needle and can be pretty painful, inducing distress, discomfort and pain. As such, there nurses need to come up with better ways of preventing pain during such medical procedures in young children.
The pediatric emergency department experiences challenges when administering healthcare to infants and young children with regards to pain management. Many medical procedures are performed by nurses right after babies are born, some of which causes pain to the children. Blood sampling is a standard nursing procedure after the baby is born. It involves piercing the baby’s skin to draw blood sample. Similarly, the subsequent months involve intensive immunization programs in which needles are used for injection. These procedures are painful as babies are being injected, causing pain-induced distress at tender age. When these pain-induced distress extend to the later stages of childhood, adverse long-term consequences can be registered. Unfortunately, very few healthcare facilities exploit evidence-based pain management strategies in neonatal care. The rationale for the selected topic is based on the need to seek appropriate and effective evidence-based interventions in pain management in neonatal care.
Star Point 2: Summary
Provision of quality healthcare requires that effective interventions be used to address the pain in children during neonatal care. Thus, this work aims to critically examine the treatment procedures that cause pain to children and propose effective ways for pain management. Prior research studies indicate that medical procedures are painful and result in significant distress among children. Even though scholars have pointed out the inadequacies in pediatric care regarding pain management, not much has been accomplished in evaluating and addressing the underlying problem by key stakeholders in the healthcare system. The most painful procedures in pediatric care include intravenous IV insertions and venipuncture.
PICOT Question
In (P) patients of young age especially infants and children, (I) does the adoption of pain-management strategies compared to (C) conventional methods (O) reduce pain during immunization, venipuncture and intravenous IV insertion medical procedures within the first (T) 12 months of consistent clinic visits?
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Sources used
During the research and interactive study period, I found the following articles quite helpful as they fully addressed evidence-based nursing practice on pain management of children in neonatal care units.
Desrosiers, A. (2020). A qualitative content analysis to identify barriers to improving neonatal
pain management practices in Ontario. 1-5. Retrieved from
https://ruor.uottawa.ca/bitstream/10393/30820/1/Desrosiers_Ashley.pdf
Hartling, L. (2018). Procedural Pain in Children: A qualitative study of caregiver experiences
and information needs. BMC Pediatrics, 18(324), 1-10.
Petovello, K. (2019). Pediatric Procedural Pain Management: A review of
the literature. International Journal of Child, Youth and Family Studies, 4(1),
569-589.
Saul, R. (2017). Methods for reducing procedural pain in children and young people. Nursing
Practice Review Pain Management, 113(7), 48-51.
Yan, C. (2020). Stress and Perception of Procedural Pain Management in Chinese Parents of
Children With Cancer. Journal of Pain and Symptom Management, 61(1), 90-102.
doi:https://doi.org/10.1016/j.jpainsymman.2020.06.028
Systemic Review summary
Desrosiers (2020) concluded that pain-induced distress in babies during venipuncture may extend to their childhood period contributing to adverse long-term consequences. This is in agreement with the observations made by Hartling (2018) indicating that intravenous IV insertions and venipuncture are painful medical procedures in babies that need a pain-management plan to avoid latter stage effects of induced pain in children. On the other hand, Saul (2017) summarizes her findings that Kangaroo care, breast feeding and child distraction are effective strategies of managing pain in neonatal care to eliminate discomfort and psychological distress. Healthcare facilities do not exploit evidence-based pain management strategies to reduce pain in neonatal care (Petovello, 2019). On his part, Yan (2020) finds it more appropriate to strengthen the existing pain management strategies in neonatal care.
Two evidence-based solutions for the trial project
One evidence-based solution that this paper recommends its trial is the use of mild anesthesia for the children during venipuncture procedures. This would reduce the pain while leaving no side effects and long-term related complications. Similarly, the other evidence-based practice to be tried out is the use of distraction cards, in which the attention of a child under immunization is drawn to the cards reducing their concentration on the actual procedure. Other methods to be tried out may include oral administration of sucrose, breast feeding and kangaroo care.
Star Point 3: Transition (Action Plan)
The care standards to support the above interventions squarely rests on caregivers and parents of the children. Educating nurses on the need to reduce pain and its long-term consequences is helpful and forms the foundation of these strategies. Similarly, parents should be aware of their role in creating a comfortable environment for the infants during immunization procedures, for instance, breastfeeding them in the process to help with pain management. Fundamentally, healthcare workers should be intuitive and enhance the efficiency of the existing pain-management procedures in neonatal care.
A list of stakeholders and their roles
Nurse leader- Is in charge of protocols and procedures in a trial project to ensure its successful outcome.
Nurse manager- Supervises the project and gets reports from the nurse leader. Is responsible for availing the required resources.
Nursing unit: The team of nurses working on the change process and offer healthcare services to children in neonatal care.
Patients: Those willing to participate in the trial project. They are aware of the risks and give their consent to be subjects of trial, and can withdraw at any stage of the project willingly.
My nursing role: as a nurse, my role is to join the nursing unit and offer the healthcare services in neonatal department thus fostering the change process.
Key stakeholders
MD-Doctor of Medicine
RN-Registered Nurse
NM-Nurse Manager
CAN-Certified Assistant Nurse
Cost analysis before the trial
The finance department shall conduct a cost-benefit analysis to weigh the anticipated benefits of the project outcome against the funds to be spent on the project. Only an economically viable option shall be adopted.
Star Point 4: Implementation
Permission -The hospital management is responsible for evaluating the acceptability of the project and granting permission. The financial department is also responsible in advising the management on the cost of the project and gives permission to avail the required funds. Nurses and patients give consent to participate.
Educating the staff- nurses must be educated on the change process to integrate it to existing pain management strategies. This is done by an experienced educator and may be organized in groups for convenience.
Timeline – the change process should take at least two years to see verifiable results. During the course of the project, adjustments can be made to increase overall effectiveness and intended results.
Measurable outcomes and recording forms: the comfortability of the babies undergoing the medical procedures shall be monitored through observation. The long-term effects like ease by which the child accepts to be taken to the clinic (based on fear, mood and anxiety) shall also be evaluated to determine if they associate clinic to painful procedures. Specially designed form for every patient shall be used to record the response to the strategy being implemented.
Resources and meeting: Meetings shall be scheduled regularly after every two months. All the medical equipment used in venipuncture and intravenous IV insertions shall be required.
Star Point 5: Evaluation
The trial outcome shall be reported to the healthcare management after analysis of the findings have been done. A report shall be compiled and distributed to all other departments, and making any clarification that could be sought.
Next steps: the results obtained shall be implemented and monitored to make improvements that might have been overlooked.
References
Desrosiers, A. (2020). A qualitative content analysis to identify barriers to improving neonatal pain management practices in Ontario. 1-5. Retrieved from https://ruor.uottawa.ca/bitstream/10393/30820/1/Desrosiers_Ashley.pdf
Hartling, L. (2018). Procedural Pain in Children: A qualitative study of caregiver experiences and information needs. BMC Pediatrics, 18(324), 1-10.
Petovello, K. (2019). PEDIATRIC PROCEDURAL PAIN MANAGEMENT: A REVIEW OF THE LITERATURE. International Journal of Child, Youth and Family Studies, 4(1), 569-589.
Saul, R. (2017). Methods for reducing procedural pain in children and young people. Nursing Practice Review Pain Management, 113(7), 48-51.
Yan, C. (2020). Stress and Perception of Procedural Pain Management in Chinese Parents of Children With Cancer. Journal of Pain and Symptom Management, 61(1), 90-102. doi:https://doi.org/10.1016/j.jpainsymman.2020.06.028
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