Abby C Kurtz, EdD, RN-BC Director, Education & Research Bronx Lebanon Hospital Center Bronx, NY 10457
1. Describe the four critical elements of an organization. 2. Describe leadership strategies that strengthen these four critical elements in the achievement of organizational goals. 3. Describe a process of transforming an organizational culture towards EBP. 2
The Barriers Scale & Evidence-based practice questionnaire (EBPQ) Organization: infrastructures and resources Research dissemination: access and process Quality of research: Skill deficit in critical appraisal Nurse: lack of time, lack of expertise, and authority 3
1. Evidence-informed clinical decision-making. 2. Evidence-based policies and procedures. 3. Evidence-informed administrative decisions and actions. 4. Evidence-based education curriculum design, content, and delivery. 4
Open and receptive to new ideas Innovation and transformation takes place at the bedside Research evidence is readily available Nurses expertise is valued Patients preferences are respected 5
1. Nurses have a professional responsibility to base their care on the best available evidence. 2. Nurses who work at the bedside know their patients - needs, values, preferences and are able to examine the evidence based on current research findings and experiential coherence and insight. 3. The organization provides leadership and structural support for EBP implementation. 6 6
CS B E SIDE 7
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Critical Elements Foundation Core Values EBP Implementation Strategy Patients First Structure Alignment: Mission People Staff Development Process Healthy environment Kurtz, A. (2010) 9
The EBP Paradigm Translation to Practice BPG Patient s preferences Contextual appropriat eness Nurse s Clinical Expertise Scientific Evidence Kurtz, A. (2010) 10
The Scientific Method Process Evaluation Current Conditions Root Cause Current Condition TEST Kurtz, A. (2010) 11
1. Compelling vision for EBP 2. Staff development 3. Create the path for EBP 4. Embed EBP in the strategy, structure and process 12
Transformative learning occurs when effective leadership strategies are employed to achieve sustainable organization change toward EBP. 13
Patient-centered Care Structural Empowerment Staff development 14
An organizational Core Value Mission, Vision Embedded in the System Structure Processes Palpable within the organizational Culture Staff development 15
Effective organizational structures are innovative, creative, have the capacity for problem-solving, and employee-empowering Resources required to learn, teach and practice EBP: Time, Space, Technology, Personnel Shared Governance (as a leadership structure) Best practice Guidelines Policies and Procedures 16
Key strategic objective Imperative leadership investment Develops nurses as knowledge workers Continuous learning environment A learning climate 17
Shared Governance Transforma tional Leadership Creative Innovation Action Processes 18
Characteristics (Schalk et al, 2010) 1. Safety: Physical, psychological 2. Professional development a. Teamwork : Collaboration b. Autonomy: Respect for the nurse s contribution c. Leadership support d. Participation in decision making 19
Improving communication Promoting knowledge transfer Supporting team work and collaboration Providing decision support at real time 20
Developing expertise Support to expertise Access to new information Access to resources 21
Jack Mezirow (1978-2004) 3 decades of theory development Emphasize contextual understanding, critical reflection on assumptions, and validating meaning by assessing reasons. Transformative learning is a subset of adult learning; NOT ALL adult learning is transformative. 22
Definition: Reflecting on the limits of knowledge, the certainty of knowledge, and criteria for knowing. We learn from subjective interpretation of experiences and focuses on HOW we know. Learning does not come from experience, but rather from reflecting on experience 23
Aim: To develop the critical thinking skills of the knowledge-worker. Goal for Nurses: To examine our actions and the views that lead to our actions by exploring the values and knowledge on which they are based. 24
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A commitment to test knowledge through reflection of experience and the willingness to learn from colleagues and from patients. Critical reflection is necessary for transformative learning. 26
Testing knowledge by observing what happens and critically appraising the evidence. 27
Role-modeling of the behaviors and skills that support the desired culture for an EBP environment: - Reflective practice - Using the scientific method - The EBP paradigm - Organizational model 28
Developing mastery for experiential coherence and insight (making sense of what is). Appraising the effectiveness of EBP pedagogy 29
THE RIGHT THING TO DO Why EBP? ack/2011 TL TL EBP 30
I. Engage: One unit at a time. II. Organizational Assessment: On-going III. Alignment and Engagement at ALL levels IV. Organizational Priorities A. Competency Assessment Program B. Pressure Ulcer management C. Nurse-to-nurse relationship 31
Strategy Structure PCC SD SE PI Structure People Resources Policy Knowledge Mgt Governance Mentors People Process Knowledgeworkers Critical thinkers Commitment Transformative learning Transformation o Recognition o Vision o Learning o Action o Integration 32
Structure: Resources: Master s prepared Facilitators, CINAHL, NRC, CDSS, HealthStream LMS; CPMRC Staff-led Committees: EBP Projects Shared Governance structure: EB Policies reviewed by Practice Cmte CPOE: CDSS; CPM Resource Center 33
Process: EBP Implementation 1. Organizational Assessment 2. EBP Training: All-levels 3. Infrastructure for innovation 4. BPG translation to practice 5. Ongoing evaluation 34
Increased number of Master s-prepared RNs EBP Scholars Program training 1-2 Research projects per year 1-2 EBP projects per year Adequate resources for information technology Focus: Sustainability of Progress 35
Practice Patient Education Quality Patient Care Flow Organizational model towards EBP/ack/2011 Leadership Operational Failures Training Preceptorship 36
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