Evidence-based practice (EBP) initiatives applied in health care settings allow for the implementation of the most efficient strategies and practices to address patients’ needs and contribute to their health outcomes.
Currently, much attention is paid to the application of EBP initiatives in the most sustainable manner to minimize negative effects on the resources, community, and environment and maximize benefits for patients (Shuman, Xie, Herr, & Titler, 2018; Skaggs, Daniels, Hodge, & DeCamp, 2018). The purpose of this paper is to discuss a recently implemented EBP initiative in a geriatric intensive-care unit of the medical center and evaluate its sustainability, as well as to recommend approaches to enhance the plan.
The EBP initiative that has been recently implemented in a geriatric intensive-care unit is a new program for preventing falls in older adults. The proposed EBP initiative has been developed concerning the latest studies and guidelines for geriatric units to reflect the most effective approaches to minimizing risks of falls. The other fall prevention program previously used in the medical center was based on outdated guidelines, and the adoption of a new program was required.
Thus, this initiative includes a new 10-step protocol to be followed by nurses, advanced screening, the assessment for falls, and specific fall intervention and prevention plans for individuals.
The discussed EBP initiative can be viewed as successful in terms of its purpose and content, but it does not address the requirements of sustainability. The problem is that the applied EBP program was not adapted to the needs of the unit with a focus on the fact that all the patients are older adults who belong to the risky category, and the threat of falls is extremely high (Kruschke, 2017).
As a result, not any program or framework based on evidence can be effectively adopted in this particular context. Sustainability in the work of a geriatric intensive-care unit and the implementation of an effective fall prevention program mean that the applied protocols address patients’ demand, and they will be used as a norm by all nurses during a long period (Shuman et al., 2018). Therefore, an effective EBP initiative should be selected carefully, and all the nursing staff should be prepared for the implementation of a new approach to meet the community’s needs and interests.
As the proposed EBP initiative is not implemented according to the principles of sustainability, it is possible to enhance its realization with the help of such a model of organizational change as Kotter and Cohen’s Model of Change. It includes eight steps, the implementation of which allows for the easy integration of EBP in health care organizations (Melnyk & Raderstorf, 2019).
They are the sense of urgency, the formation of a team, vision development, communication, empowerment, and removal of barriers, short-term wins, continuation, and making changes work (Baloh, Zhu, & Ward, 2018). To enhance the sustainability of implementing the fall prevention program, it is necessary to focus on the following steps: communication of the change, the removal of barriers, and the creation of short-term wins (Huang-Saad, Stegemann, & Shea, 2019; Small et al., 2016).
The vision should be directly related to outcomes for older patients, developed standards should address the culture of a geriatric intensive-care unit, the implementation should be supervised by leader nurses, and short-term wins should demonstrate that the goal is achievable.
EBP initiatives can be implemented through the application of specific models that guide organizational change. Although the proposed initiative addresses the needs of the unit, and the topic was selected and researched appropriately, the complete implementation of Kotter and Cohen’s Model contributes to achieving more positive outcomes for patients. Furthermore, the nursing staff receives an opportunity to adapt to a new model and add to improving its sustainability through participation in the assessment of results.
References
Baloh, J., Zhu, X., & Ward, M. M. (2018). Implementing team huddles in small rural hospitals: How does the Kotter model of change apply? Journal of Nursing Management, 26(5), 571-578.
Huang-Saad, A., Stegemann, J., & Shea, L. (2019). Developing a model for integrating professional practice and evidence-based teaching practices into BME Curriculum. Annals of Biomedical Engineering, 1, 1-12.
Kruschke, C. (2017). Evidence-based practice guideline: Fall prevention for older adults. Journal of Gerontological Nursing, 43(11), 15-21.
Melnyk, B. M., & Raderstorf, T. (Eds.). (2019). Evidence-based leadership, innovation and entrepreneurship in nursing and healthcare: A practical guide to success. New York, NY: Springer Publishing Company.
Shuman, C. J., Xie, X. J., Herr, K. A., & Titler, M. G. (2018). Sustainability of evidence-based acute pain management practices for hospitalized older adults. Western Journal of Nursing Research, 40(12), 1749-1764.
Skaggs, M. K. D., Daniels, J. F., Hodge, A. J., & DeCamp, V. L. (2018). Using the evidence-based practice service nursing bundle to increase patient satisfaction. Journal of Emergency Nursing, 44(1), 37-45.
Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotter’s change model for implementing bedside handoff: A quality improvement project. Journal of Nursing Care Quality, 31(4), 304-309.