Review of Literature
Describe about the Regular Pashient with Nursing Practice.
Grol et al (2013) has conducted a systematic review based on factors impacting the change of care from evidence to practice and in effectively implementing these changes in the care of patients. They found that great difficulties arise when changing the care from evidence and clinical guidelines into regular patient practice. The change behavior requires the cooperative approaches by all the team members (doctors, nurses, etc) according to various settings and target people. They outlined a concise review of current knowledge regarding various approaches involved in the changes in medical field. They have considered 3 basic aspects in this research as evidential attributes, obstacles faced and things that promote changes in practice to disseminate and implement these changes effectively.
The researchers used the individual reviews by vote counting methods and made both positive comparison and negative comparison to find the effectiveness of the interventions. But these methods do not provide an adequate size (effect) of interventions. So they performed a systematic review by including 235 numbers of assessments for determining the dissemination of guideline and the strategies for change used for implementation. They found that the following factors such as lack of financial incentives to employees, restrictions to practice change in organizations, lack of time, risk of formal complaint, doubt in patient’s expectations and satisfaction, disagreement for change by the head of the authority, lack of medical knowledge and self confidence in practicing the changed skills, inability to appraise evidence may affect the standards of practice and routines. They concluded that the process of change from obtained evidence to the practice is very easy but this is impacted by those factors directly.
Coombes in 2008 has conducted a qualitative study to evaluate the associated factors with the medication errors related to prescribing of medications produced by interns working in the hospital. He found that the medication error is caused by many factors. This indicates that 90% of the error is caused by environmental factors, nearly 76% by team related factors, approximately 76% by individual related factors, up to 76% with task based factors and only 62% by patient factors. The study shows that the environmental factors includes the aspects such as levels of staffing, staff skill mix, staff workload, design of staff workflow and administrative support. They found that the task factors that includes the design of chart for medication, its protocols and medication availability of test instruments with accurate test result and individual factors as knowledge, attitude and skills, ability to gain motivation and health of the individual affects the implementation of change in the hospital settings related to medication administration. Even it is associated with team factors such as method of communication and supervision and structure of hospital organization and patient factors as the condition of patient.
In 2008, Nichols has conducted the similar study to confirm the factors related to the errors that occurs during the prescription of medication in Western Australia. He studied 29 medication errors in which 21 is due to slip/ lapse error. He found that the individual (staff and administration), team factor, patient factor and environmental factor contribute to the medication error. He also found that the errors mostly occur when the medication is administered after tough hours, distracted staff and improper communication. He concluded that these factors adversely affect the implementation of change in medication administration in hospital setting whereas the study by Lederman (2005) found that the change is due to the lack of facility to access on-line information and absence of connectivity. They concluded from the result that the prescription by the help of electronic devices, indenting medication and medication dispensing systems should be made appropriately to avoid medication errors caused by the environmental factors.
Factors impacting change of care from evidence to practice
Bennet (2003) studied about implementing the new clinical guidelines in change management especially the role of manager in implementing the new CPGs on sedation among pediatrics admitted in the intensive care setting. The researcher concluded that there are various aspects in the management to indicate the need for change, understand the health care professional’s view, in reviewing the literature, training the implementers, compiling, implementing and reviewing the draft guidelines. This study discusses the role of a change agent in pediatric intensive care setting.
Berta (2005) has conducted a study to determine the factors that influence the acute care settings in implementing, transferring and retaining patient safety practices among patients in North America. He examined the aspect of readiness of organization for change in patient safety. They reviewed the literature related to change in management, motivation for learning in organization, transfer of knowledge and practice of evidence based research. They identified that the factors related to patient safety varies based on the structure of organization, leadership, organizational culture, method of prioritizing the strategy, communication skill, knowledge and experience with change and resources. They designed a draft tool to assess the readiness of organization based on the change in patient safety practices in hospital settings to assist them in finding the areas that requires action before introducing the change whereas Rashidan (2003) described about few guidelines especially in primary care organizations as to identify the influential person and available organizational factors (resources), planning and implementation of change strategies and to monitor the result.
Berenholtz (2003) proposed a study to assess the obstacles in translating the evidence based care into best practice in intensive care unit. The authors reviewed the evidence based on changes in behavior of health care professionals (physicians) and discussed the limitations. They discussed the barriers related to independent redundancy, teamwork and complexity and methods to overcome these obstacles in the intensive care unit to improve the quality of care.
Pipe et al (2005) has conducted a research study to assess the implementing aspect of evidence related nursing practice in medical surgical nursing. The researchers have given a framework for transforming the evidence of care into practice which involves the assessment of the need for change, connect problem intervention with outcomes, generate good evidence, developing a change in practice of a nurse in clinical settings, implementing and evaluating the effect of change in practice.
A qualitative study was conducted to identify the challenges faced by the hospital in the process of adapting the hospital based elderly life- program by Bradly in 2004. The main motive is to assess the issues that promotes or prevents its implementation. They found various challenges encountered by hospital staffs in the implementation of change such as lack of internal support, effective leadership, clear integration with already existing programs, balancing with changes and maintaining the document of implementation. They have framed strategies to address these challenges.
In 2002, Bartels reviewed the evidence related practices that is implemented in the mental health settings for elderly people. They reviewed the obstacles and various approaches to implement evidence related practice for old age people residing in mental health setting. They suggest that the continuing medical education, integrated healthcare management and analyzed toolkits can be used to effectively implement the care whereas in 2010, White et al has conducted a study to review the challenges faced by the physicians in acute care settings of rural Australia. They identified the challenges in implementing the change as inequity in access to health care, risk factors, increased mortality rates, accidents in rural areas and unavailability of resources.
Obstacles and factors that promote changes in practice
A checklist was developed by Colton 2004 for assessing the organizational readiness for reducing seclusion and restraint. This includes a checklist that helps to identify the factors that contributes in reducing seclusion and restraint. The assessment areas includes leadership, orientating and training of staff, staffing pattern, environment related factors, organizational structure, treatment planning (responsive), debriefing sessions, communication, involvement of consumer, evaluation of change and quality improvement and Greenhalgh et al (2004) suggested various elements of readiness in organizational system that modifies the organizations from the receptive context for change to a ready to change type. These elements include change tension, system innovation, assessing the implications, organizational support, needed advocacy, time, other resources spent and capacity to evaluate the innovation.
In 2004, Malone has explored the factors that impact in implementing the evidence related findings to practice. The findings suggest that there are many factors that affect the implementation as difficulty in interpreting the change result, lack of organizational support, improper directing, and lack of motivation whereas Nemeth in 2003 has reviewed the literature related to implementing the change to produce effective outcomes. He suggested that the factors such as effective communication, appropriate leadership, coordinated activities and integrating the changes into practice are very important to achieve positive outcomes which will improve the quality of a management.
Fornilli, 2005 discusses about various organizational factors influencing the acceptance of innovation and evidence based practices. The researcher described about various conditions, factors influencing, needed tools, models and adequate resources that is needed in the implementation and maintenance of the individual as well as institutional changes whereas Ockene et al in 2000 has examined the change in educational strategies in hospitals. They evaluated the various levels of organization and clinical area and described the challenges and recommendation for continuing education for skill building the physicians.
Herscovitch, 2002 has proposed a study to assess the multi-dimensional relationship between the commitment to change and behavior of employee. He studied various components of employee’s commitment such as normative, affective and continuance. They also identified that the commitment to change of an employee is a better indicator than behavioral support of an employee. Furthermore developing an affective commitment is important to change the employee’s behavior. In other hand Horwath (2000) has identified and implemented the pathways for organizational change that are involved in assessing the children (in need) and their families. He has described about the 6 change process as pre contemplating, contemplating, determining, taking action, maintaining and relapsing if needed.
References
Bartels, S. J., Dums, A. R., Oxamn T. E., Schneider, L. O., Arean, P. A., Alexopoulos, G. S., Jeste, D.V. (2002). Evidence-Based Practices in Geriatric Mental Health Care. Psychiatric Services, 53(11): 1419-1431.
Bennet, M. (2003). Implementing new clinical guidelines: the manager as agent of change. Nursing Management, 10 (7): 20-23.
Berenholtz, S. & Pronovost, P. J. (2003). Barriers to translating evidence into practice. Curr Opin Crit Care, 9: 321-325.
Berta, W., Baker. G. R. (2005). Factors Impacting the Implementation, Transfer and Retention of Patient Safety Best Practices in North American Acute Care Hospitals: Assessing Organizational Readiness for Practice Change. Retrieved from www.hret.org/chmr/resources/cp02a.pdf
Bradly, E. H., Schlesinger, M., Webster, T. R., Baker, D. & Inouye, S.K. (2004). Translating research into clinical practice: making change happen. JAGS, 52:1875-1882.
Colton, D. (2004). Checklist for assessing your organization’s readiness for reducing seclusion and restraint. Commonwealth Center for Organizational Readiness for Practice Change. Children and Adolescents. Staunton: Virginia
Coombes, I. D., Stowasser, D. A., Coombes, J. A. & Mitchell, C. (2008). Why do interns make prescribing errors? A qualitative study: Med J Aust, 188: 89–94.
Fornilli, K. (2005). Organizational Readiness for Implementing Evidence-Based Practices. (2005). Journal of Addictions Nursing, 16:87-89.
Greenhalgh,T., Robert. G., Macfarlane. F., Bate, P., and Kyriakidou, O. (2004). Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations, 82(4): 581–629. doi: 10.1111/j.0887-378X.2004.00325.x
Grol, R. (2003). From best evidence to best practice: effective implementation of change in patients’ care: The Lancet, 362: 1225–30. Retrieved from www.thelancet.com 1225
Herscovitch, L., Meyer, J.P. (2002). Commitment to organizational change: extension of a three-component model. Journal of Applied Psychology, 87(3): 474-487.
Horwath, J., Morrison, T. (2000). Identifying and implementing pathways for organizational change – using the Framework for the Assessment of Children in Need and their Families as a case example. Child and Family Social Work, 5: 245-254.
Lederman, R. M. & Parkes, C. (2005). Systems failure in hospitals – using Reason’s model to predict problems in a prescribing information system. J Med Sys, 29: 33–43. doi: 10.1007/s10916-005-1102-2.
Nemeth, L.S. (2003). Implementing change for effective outcomes: Outcomes Management, 7(3): 134-139.
Nichols, P., Copeland, T. S., Craib, I. A., Hopkins, P. & Bruce, D. G. (2008). Learning from error: identifying contributory causes of medication errors in an Australian hospital: Med J Aust, 188: 276–279.
Ockene, J.K., Zapka, J.G. (2000). Provider education to promote implementation of Clinical Practice Guidelines. CHEST, 118:33-39.
Pipe, T. B., Wellik, K.E., Buchda, V. L., Hansen, C. M. and Martyn, D. R. (2005). Implementing Evidence-Based Nursing Practice. MEDSURG Nursing, 14(3): 179-184.
Rashidan, A., Russell, I. (2003). Towards better prescribing – a model for implementing clinical guidelines in primary care organizations in the NHS. Clinical Governance, 8(1):26-32.
Rycroft-Malone, J., Harvey, G., Seers, K., Kitson, A. McCormack, B., Titchen, A. (2004). An exploration of the factors that influence the implementation of evidence into practice. Journal of Clinical Nursing, 13:913-924. doi: 10.1111/j.1365-2702.2004.01007.
White. A. & Smith. A. (2010). Challenges confronting clinicians in rural acute care areas. Review of literature. Retrieved from https://journals.sfu.ca/hneh/index.php/hneh/ article/viewFile/64/55
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