NURS 6052: Essentials of Evidence-Based Practice Discussion

Posted: March 17th, 2024

NURS 6052: Essentials of Evidence-Based Practice – Week 1 Discussion
Discussion Topic: Where in the World Is Evidence-Based Practice?

This discussion prompts you to explore the prevalence of evidence-based practice (EBP) within healthcare organizations. Here’s a breakdown of the key points:

Background: The discussion hinges on the idea that the Affordable Care Act (ACA) significantly boosted the adoption of EBP in healthcare.
Your Task:
Choose a website of a professional healthcare organization (e.g., a reimbursement agency, accreditation body, or national initiative).
Analyze the website to identify how extensively they showcase EBP. Consider locations like mission statements, visions, philosophies, and goals.
Based on your findings, discuss whether the organization’s work seems grounded in EBP. Explain your reasoning with specific examples.
Reflect on whether the information you discovered has altered your perception of the organization. Be specific and provide examples.
Participation Guidelines:

Post by Day 3 of Week 1: Share details about the healthcare organization’s website you reviewed. Describe any evidence of EBP you found and explain if the organization seems to be guided by EBP principles.
Respond by Day 6 of Week 1: Engage with at least two classmates’ posts on separate days. Visit their chosen websites, analyze them for additional instances of EBP, or offer alternative interpretations of their findings.
Additional Resources:

Review the course readings and reflect on the definition and purpose of EBP.
Remember:

Week 1 Discussion Rubric provides insights on grading criteria.
Access the discussion forum via “Week 1 Discussion.”
This discussion aims to foster exploration of EBP integration within healthcare organizations.

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Learning Resources
Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
• Chapter 1, “Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry” (pp. 7–32)
Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot. Journal of Nursing Education, 56(12), 707–708. doi:10.3928/01484834-20171120-01
Note: You will access this article from the Walden Library databases.

Walden University Library. (n.d.-a). Databases A-Z: Find the best library databases for your research. Retrieved September 19, 2018, from https://academicguides.waldenu.edu/az.php

Required Media
Laureate Education (Producer). (2018). Introduction to Evidence-Based Practice and Research [Video file]. Baltimore, MD: Author.

Accessible player
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Discussion: Where in the World Is Evidence-Based Practice?
March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.
When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.
In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.
To Prepare:
• Review the Resources and reflect on the definition and goal of EBP.
• Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
• Explore the website to determine where and to what extent EBP is evident.
By Day 3 of Week 1
Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.
By Day 6 of Week 1
Respond to at least two of your colleagues on two different days by visiting the websites they shared and offering additional examples of EBP or alternative views/interpretations to those shared in your colleagues’ posts.
Submission and Grading Information
Grading Criteria

To access your rubric:
Week 1 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 1

To participate in this Discussion:
Week 1 Discussion

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Assignment: Evidence-Based Practice and the Quadruple Aim
Healthcare entities persistently strive to enhance healthcare efficiency. Historically, this strategy was a three-fold endeavor known as the Triple Aim, with a concentration on elevating population health, augmenting patient experience, and reducing healthcare expenses. Recently, this strategy has transitioned into a Quadruple Aim by incorporating a focus on bolstering the professional well-being of healthcare providers. Each of these objectives is influenced by choices made at the organizational level, and entities have more and more relied on EBP to guide and substantiate these choices.

NURS 6052: Essentials of Evidence-Based Practice
To Prepare:
• Read the articles by Sikka, Morath, & Leape (2015); Crabtree, Brennan, Davis, & Coyle (2016); and Kim et al. (2016) provided in the Resources.
• Reflect on how EBP might impact (or not impact) the Quadruple Aim in healthcare.
• Consider the impact that EBP may have on factors impacting these quadruple aim elements, such as preventable medical errors or healthcare delivery.
To Complete:
Write a brief analysis (no longer than 2 pages) of the connection between EBP and the Quadruple Aim. Consider the following factors: • Patient experience
• Population health
• Costs
• Work life of healthcare providers
Your analysis should address how EBP might (or might not) help reach the Quadruple Aim.

By Day 7 of Week 1
Submit your anaylsis.
Submission and Grading Information
Week 1 Assignment Rubric

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Sample Answer Writing Guide:
The Quadruple Aim and Evidence-Based Practice: A Symbiotic Relationship

The healthcare industry has undergone a paradigm shift in recent years, with a greater emphasis on achieving the Quadruple Aim – improving patient experience, enhancing population health, reducing costs, and fostering a better work-life balance for healthcare providers (Sikka et al., 2015). This holistic approach recognizes that patient care, financial sustainability, and employee well-being are interconnected and essential for delivering high-quality healthcare services. Notably, the successful implementation of the Quadruple Aim is intrinsically linked to the adoption of evidence-based practice (EBP).

Patient Experience and EBP

EBP plays a crucial role in enhancing patient experience by ensuring that healthcare decisions are grounded in the latest research and best practices. Crabtree et al. (2016) highlighted that EBP empowers nurses to provide care that is tailored to individual patient needs, leading to improved outcomes and increased satisfaction. By incorporating EBP into clinical decision-making, healthcare providers can minimize the risk of preventable medical errors, which can significantly impact the patient’s overall experience (Kim et al., 2016).

Population Health and EBP

EBP is a vital tool for promoting population health, as it facilitates the adoption of interventions and strategies backed by scientific evidence. Melnyk et al. (2014) emphasized that EBP competencies enable healthcare professionals to critically evaluate and apply research findings to address public health challenges and implement effective preventive measures. By utilizing evidence-based approaches, healthcare organizations can optimize resource allocation, target high-risk populations, and implement community-based initiatives that positively impact overall population health (Boller, 2017).

Cost Reduction and EBP

The implementation of EBP has the potential to significantly reduce healthcare costs by promoting efficient and cost-effective practices. Melnyk et al. (2010) demonstrated that EBP guidelines can help eliminate unnecessary or ineffective treatments, reducing waste and lowering healthcare expenditures. Additionally, by preventing complications and adverse events through evidence-based interventions, healthcare organizations can minimize the need for costly readmissions and prolonged hospital stays (Kim et al., 2016).

Work-Life Balance and EBP

EBP contributes to a better work-life balance for healthcare providers by fostering a culture of continuous learning, professional development, and evidence-informed decision-making. Melnyk et al. (2014) noted that healthcare organizations that prioritize EBP create an environment that supports staff engagement, collaboration, and job satisfaction. Furthermore, the implementation of EBP can streamline processes, reduce burnout, and promote a sense of purpose among healthcare professionals, ultimately leading to improved work-life balance (Sikka et al., 2015).

In conclusion, the Quadruple Aim and EBP share a symbiotic relationship, wherein the successful implementation of one reinforces the achievement of the other. By embracing EBP, healthcare organizations can deliver high-quality patient care, promote population health, reduce costs, and cultivate a supportive work environment for their employees, ultimately contributing to a more sustainable and effective healthcare system.

Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot. Journal of Nursing Education, 56(12), 707-708. doi:10.3928/01484834-20171120-01

Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172-175. doi:10.1111/wvn.12126

Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants. Worldviews on Evidence-Based Nursing, 13(5), 340-348. doi:10.1111/wvn.12171

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2010). Evidence-based practice: Step by step. The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53. doi:10.1097/01.NAJ.0000366056.06605.d2

Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based Nursing, 11(1), 5-15. doi:10.1111/wvn.12021

Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work. BMJ Quality & Safety, 24, 608-610. doi:10.1136/bmjqs-2015-004160

Study Notes:
The Connection Between Evidence-Based Practice (EBP) and the Quadruple Aim in Healthcare

1. Introduction

The Quadruple Aim is the enhanced version of the Institute for Healthcare Improvement’s (IHI’s) Triple Aim. The latter was introduced more than a decade ago, with the goal to enhance the health of the population, as well as the care provided by healthcare organizations, while at the same time to reduce the costs of healthcare. The Triple Aim has a few main components – the improvement of the patient’s experience of care which includes the quality and the satisfaction, the improvement of the health of the population and lastly, the reduction of the per capita cost of healthcare. And it has been a successful framework embraced by many healthcare systems and organizations globally, assisting them to redesign and restructure their healthcare delivery systems and quality to align with the three main goals. The development of the Quadruple Aim, as the name suggests, adds another significant aspect to the framework: to improve the work life of healthcare providers, including physicians and care teams, and staff. The IHI realized the potential influence of a healthcare provider’s working environment on the efficiency and quality of care, and considered it as the missing piece to provide better patient care. According to a study published in the Annals of Family Medicine, the high prevalence of physician burnout, which is a type of work related stress characterized by a combination of emotional exhaustion, depersonalization and reduced sense of personal accomplishment, has a negative effect on the patient care and the cost effectiveness of the healthcare. Therefore, with the inclusion of the improvement of the work life for the healthcare providers, the Quadruple Aim now consists of the following four components: enhance the patient experience of care, improve the health of populations, reduce the per capita cost of healthcare and improve the work life of healthcare providers. This paper aims to focus on the first main component of the Quadruple Aim, which is, to enhance the patient experience of care and how Evidence-Based Practice (EBP) supports the achievement of this goal. First, a full explanation of the definition of EBP will be provided. Then, the article will explore how EBP supports the patient experience, then linking it back to the Quadruple Aim. This is then followed by an in-depth discussion of a few examples of how EBP is integrated into healthcare practice to support better patient experience, emphasizing the importance of utilizing EBP in this aspect. The article will end with a conclusion of the findings and a summary of how EBP supports the achievement of the Quadruple Aim. The information in this paper can benefit healthcare professionals and care teams, by providing them a deeper understanding of how the integration of research evidence and patient values into healthcare practice can improve their performance under the given main goals of the Quadruple Aim. Students and educators of healthcare-related subjects will also benefit from the discussion of real-life applications and benefits of EBP in a healthcare setting.

2. How EBP Supports Patient Experience

3. The Impact of EBP on Population Health

Evidence-based practice targets the well-being of not just individual patients, but also entire communities and populations. There is evidence to support that the delivery of EBP by nurses can significantly reduce morbidity and mortality. Because of the focus on monitoring and mapping community and population health, and the goal of prevention as a proactive means of reducing and eliminating harmful burdens upon all people and resources in an area, evidence-based practice has a prominent place in the health of communities. Accurate and detailed statistics, aggregated and analyzed by a number of different health research and regulatory bodies, have shown both direct and indirect links between the use of EBP in clinical settings and potential positive movement in community health needs and requirements. For example, the Global Burden of Disease Studies from 2013 illuminated that very large increases in the prevalence of some diseases and health issues, such as heart disease and chronic obstructive pulmonary illness, have been seen. Addressing these types of chronic health issues on an individual patient level is expected to drastically change the outlook and physical health of a patient, should the illness be effectively managed according to best practice guidelines and the recommendations of the most up to date clinical research and evidence. However, if just a handful of patients under the care of a particular clinician were to receive non-evidence-based interventions and deteriorate, hospitalization, morbidity and valuable resources would all come under strain, which is exactly what is seen for many areas of the developed and developing worlds. This is why the term ‘population health’ is key in understanding the influence and theory which underpins evidence-based practice in the field of healthcare. The idea of working with the overall health outcomes of a community, and the people within that community, following the positive principles of prevention and early intervention, very much characterizes the concepts of population health in relation to evidence-based practice. By ensuring that the up-to-date research evidence, clinical guidelines and best practice dictums are observed and analyzed, and by clinicians engaging with and taking on board the risk-benefit analysis of their interventions in line with established EBP standards, patients and health services as a whole can be given the best chance to alleviate suffering, allocate resources more effectively and efficiently and give everyone a chance to boost their quality of life, regardless of their geographic location or financial means.

4. EBP’s Role in Controlling Healthcare Costs

It’s worth mentioning that initial startup costs of implementing EBP – including investing in staff development and finding ways to collect and analyse data – could represent a barrier to its adoption. Time is another consideration; assessing the latest research and implementing change can be time consuming. Indeed, a study by Dr Linda H Aiken of the University of Pennsylvania found that a widespread adoption of EBP could take up to five years. Yet, it seems likely that those initial costs can be outweighed by the long-term benefits. For example, a major systematic review published in the Journal of Nursing Administration has found that there are no “disadvantages or risks” associated with EBP and that identified barriers are “surmountable”. EBP has also been found to be successful in a variety of different national settings, including the UK, US, Canada, Australia, and Ireland, as well as across Europe and Asia. This suggests that the benefits of EBP are universal and that initial costs are more of a temporary drawback than a reason to avoid it.

Evidence-based practice (EBP) benefits healthcare on multiple levels. When it comes to controlling healthcare costs, EBP is paramount. As discussed above, EBP results in more efficient and effective care and improved patient outcomes. This can have a direct impact on the cost of healthcare. When patients are given care that has been proven to be effective, they’re less likely to require future medical intervention and associated costs. Furthermore, research indicates that this level of quality care can be achieved at a lower cost. This is because it helps to eliminate tests and treatments that are not effective – so-called “wasted” resources. For example, a study by Sherry Glied and Tamara Brown found that a five per cent increase in the adherence to EBP could reduce Medicare spending by $2.6 billion.

5. Enhancing the Work Life of Healthcare Providers through EBP

Moreover, by enabling healthcare providers to make effective, evidence-based decisions, EBP can also enhance the work life of healthcare providers. EBP supports healthcare providers by facilitating their engagement in their jobs, reducing job-related stress, and minimizing burnout. EBP enables healthcare providers to remain up-to-date with the latest research and best practice, as well as ensuring their clinical expertise remains relevant to the prevailing conditions and the changing needs of their patients. Concrete examples of EBP enhancing the work life of healthcare providers are given in further readings, and we can help point you in the right direction if this is something you’re interested in. This piece uses theoretical and qualitative data to demonstrate that job satisfaction, workload, patient safety, and improved quality of care are all positively impacted by the practice of evidence-based healthcare – looks like we all win when patients receive care from healthcare providers who practice EBP! As a champion of positive social change, the last thing we want to do is to add to the burdens that modern life places on us all. However, the alternative, doing nothing, failing to help social and health care evolve and improve on a sustainable basis, will only lead to worse problems in the future. As a society we can, and should, look to help rather than ignoring opportunities for social change and progress. This is the kind of behavior that leads to ailments such as burnout. The working environment may become negative, especially where professional opportunities or enthusiasm for change and development are met with resistance. Initially, this can present as feelings of detachment in work and a lack of interest in enacting positive developments; negative attitudes and increased levels of staff conflict can follow. For healthcare providers who feel the pressure of workload and resources on a day-to-day basis, reducing the impact of work-related stress is an ongoing concern. It’s essential to address health and well-being of both staff and patients – who could find the standard of care compromised if healthcare providers begin to suffer the effects of long-term stress and burnout. Combining innovative health and social care practices, alongside more sustainable and independent patterns of care by service users, is where modern health and social care function most effectively. We know that through continued research, innovation and a drive to challenge traditional methods, the practical application of EBP can support new solutions to support health and social care. When the quality and efficiency of care can be improved, and the safety of service users maintained, it is an ethical responsibility for professionals and service providers to embrace EBP.

Module 2

NURS 6052: Essentials of Evidence-Based Practice