How does a nurse, faced with a problem,
begin the process of quality improvement? Hopp and Rittenmeyer (2021) indicate
that armed with data, nurses use the best available literature to guide
practice.
Your assignment this week will spark your
curiosity about how nurse leaders spur change. You are probably aware of
problems at work that you would like to review. Nurse leaders drive quality
improvement processes. This week, we are asking you to use an evidence-based
approach to a problem.
The problem should be related to leadership
and management concepts that we are studying in this course. You can focus on best practice
guidelines, improving work environments, promoting safety, and/or system
change. Some examples of issues that require system change may be medication
errors among nurses who work 12 hour shifts on your unit, or increased
re-admissions of cardiac surgery patients after discharge. Other examples
might be absenteeism among nurses on a particular care unit; or decreasing
patient fall rates in the ICU; or improving change of shift reporting among
nurses. These are just a sample of the many types of problems that you
might choose for this assignment. Still, other examples or ideas may be
found in Chapter 23 of your Huston textbook.
Directions: You will write a 1-3 page
document in APA format addressing each of the following items (#1-4).
1. Identify a current problem (related to a leadership and
management concept) within a health care work environment that requires a
quality improvement initiative. Please
write a paragraph about the problem.
2. Imagine you are asked to lead an
evidence-based initiative that addresses the problem. You are asked to develop a PICO question to narrow and
specify your problem. The PICO question will guide your search
for the best available evidence. Here’s some helpful hints…
The PICO elements needed for a good
research question are:
P- population: be specific about that
population. As an example, if you are interested in retention rates of nurses,
be as specific as you can about the population. Perhaps you are interested in
newly graduated nurses’ working on a medical-surgical unit. Think about how
best to describe the population?
I- intervention- be specific about the
intervention your population receives. You will be searching for the highest
level of evidence in the literature. Remember, you are not doing a research
project. Instead, you are trying to find the best available evidence to support
a change and/or quality improvement intervention. Another thing to think
about – is this a nurse specific intervention? Practice changes that involve
other stakeholders (managers and/or inter-disciplinary team members) would also
require them to be at the table.
C-comparison Who is your comparison group?
Did half the group in the study receive the intervention and the other half did
not? The literature will tell you the answer. In the example of newly graduated
nurses, some interventions might be a formal orientation program, assignment of
a mentor, or the establishment of a clinical ladder. Whereas, the comparison
could be newly graduated nurses that did not receive the
intervention.
O- outcome what outcome do you want to
measure? Ex. retention rates on the medical surgical unit with intervention
versus without.
Here is an example of a well-written PICO
question addressing a hand hygiene practice initiative: What is the
effectiveness of offering mandatory training sessions (I) compared to posting
signs in the hospital (C) on improving adherence to the hospital hand hygiene
protocol (O) among nurses in the ICU (P)?
Make sure to write your PICO question in
the assignment. Label the parts of the question to receive all points.
3. Search for a minimum of three (maximum
of five) research (scholarly) articles published within the last 10 years that
relate to the chosen problem. Note: Focus on higher levels of evidence whenever
available. Use
APA format to reference each article at the end of your assignment.
4. Summarize and synthesize the evidence as it relates to your
question.
a. Summarizing your article means that you
are articulating general findings in your own words for each of the three (3) articles cited on your
reference list.
b. Synthesizing is applying the findings
to the problem you have identified in step 1.
References:
Hopp, L., & Rittenmeyer, L. (2021).
Introduction to evidence-based practice: A practical guide for nursing (2nd
Ed.) F. A. Davis. ISBN: 978-0-8036-6663-4
Huston, C. J. (2024). Leadership
roles and management functions in nursing: Theory and application (11th
ed.). Wolters Kluwer. ISBN: 978-1-9751-9306-5