Posted: July 15th, 2023

UPDATING A POLICY FOR EVIDENCE-INFORMED PRACTICE AND PATIENT-CENTERED CARE

Critical Appraisal Paper (20%) + Presentation (5%)

Purpose:
Your professional commitment to advance significant policy changes can be pivotal in your career advancement while helping you stay current on practice trends and acquire new experiences and skills. To create innovative healthcare solutions, healthcare providers (nurses) continue to re-examine how healthcare is delivered and engage stakeholders strategically (management and leadership), experts, and sometimes legislators to bring about the best practice change. As a nurse, you will encounter ongoing practice changes as directed and updated by your chosen organizational policy. You may be involved in this process and examine how recent research may impact patient care and nursing practices. i.e., you are updating the process for central line dressing changes to reduce Central Line-Associated Bloodstream Infection (CLABSI) or unplanned extubations in your critical care unit (Wollny et al., 2022). You can search CINAHL or PubMed for reputable references and present the information concisely using Situation – Background – Assessment – Recommendation (SBAR). Many policies are under review for patient partnering (their input and critique are considered and asked) and cultural safety. Incorporating ways to include this lens and informed practice perspectives are part of this assignment.

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Wollny, K., Cui, S., McNeil, D. et al. Quality improvement interventions to prevent unplanned extubations in pediatric critical care: a systematic review. Syst Rev 11, 259 (2022). https://doi.org/10.1186/s13643-022-02119-8

Background reading:

Please read Chapter 20 – Critiquing Quantitative Research from our course textbook LoBiondo-Wood and Haber’s Nursing Research in Canada.

Jurns, C. (2018). Using SBAR to Communicate with Policymakers OJIN: The Online Journal of Issues in Nursing 24(1). https://doi.org/10.3912/OJIN.Vol24No01PPT47

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Shahid, S., Thomas, S. (2018). Situation, Background, Assessment, Recommendation (SBAR) Communication Tool for Handoff in Health Care – A Narrative Review. Saf Health 4(7). https://doi.org/10.1186/s40886-018-0073-1

Learning Outcomes (CNO) Related to this Assignment:
5.1 Consults with clients and healthcare team members to make ongoing adjustments required by changes in the availability of services or client health status.
5.2 Monitors client care to help ensure needed services happen at the right time and sequence.
9.1 Use the best evidence to make informed decisions.
9.2 Translates knowledge from relevant sources into professional practice.
Overview of Project Assignment:

1) Select a topic or learning area of personal interest relevant to the area of nursing you currently work in or hope to work in (e.g., critical care, public health, pediatrics…). Include your CHOSEN policy reference in APA format on the reference page.

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2) Find ONE Canadian inpatient policy to use for this assignment. Not all organizations have a public-facing policy. The provinces of BC and NS have many available.
Examples of policy:

Kingston General Hospital. (2014). Central Lines Advanced Competency for Nurses: Pediatric (RNs and RPNs) (C-1804).https://kingstonhsc.ca/sites/default/files/uploads/ipo-c-1804_-_central_lines_advanced_compentency_for_nurses_-_pediatric_2014_oct.pdf

If you cannot find a policy for your chosen topic, you can create an SBAR to propose a working group to develop a specific policy.

3) Conduct a Brief Literature review:
After selecting the policy or guideline related to your area of interest, do a brief literature review to find emerging research related to this topic.
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TIPS: Research Evaluation Checklists (to review – not to be included in the assignment)
• https://tlp-lpa.ca/health-sciences/home

Considerations:
What are ways to update the policy for more evidence-informed practice? How is patient and cultural safety improved? Remember, patient care doesn’t change over one publication. Look to Cochrane Reviews and systemic review papers. Consider the hierarchy of research when selecting your references. Is there more recent research supporting this policy or a policy change to consider by clinical practice leadership (e.g., unit manager, educator, nursing practice leadership across the hospital/organization)? Include at least one cultural safety reference.

4) Complete the SBAR template below (maximum four pages) that could be used to present at a team meeting (e.g., unit team meeting or at a nursing organizational, professional practice meeting to hospital leadership or other committees like Patient-Centered Care or Quality and Safety. You can assume that your reader (nursing colleagues, multidisciplinary partners, manager, and leadership) has some knowledge of the policy topic. Still, this assignment focuses on effectively addressing the need and opportunity to become more familiar with evolving research. Please include a title page using APA formatting and a reference page. Delete the prompters and leave S – B- A- R for more space.

5) What to hand in:
1. Title Page APA 7th Ed. Format.
2. Four pages Maximum SBAR
3. Reference Page. Minimum five references, including three at least one cultural safety reference and reference for the policy you have selected. Focus on quantitative research articles.

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SBAR Template – Please complete and turn in on CANVAS as described above.

Situation: (a concise statement of the problem)
Are there any noted gaps? Are literature updates relevant to chosen policy?
Authors; Key Contributors: (what multidisciplinary team members are relevant); Problem Statement:

Background: (pertinent and brief information about the situation) Describe and summarize the current policy; include the hospital's name, relevant patient population and nursing setting. Literature Review & Best Practice

Assessment: (analysis and considerations of options – what you found/think) Address economic concerns of the policy update. Identify ways to notify staff nurses of policy updates. Identify equity and Cultural Review Considerations. Identify patient Safety Improvements or Measurements. What you found – outline options and considerations of advantages, disadvantages, impact on care, financial implications and risks as needed/relevant)

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OPTION #1:

Pros:

Cons:

OPTION #2

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Pros:

Cons:

Recommendation: (action requested/recommended – what you want)

We recommend OPTION #___:
Consultations: [Check the box for recommended consultations to support the proposed recommendation]
☐ Finance
☐ Facilities
☐ Information Services
☐ Director(s)
☐ Patient Care Leadership Team (PCLT)
☐ Occupational Health & Safety (OHS)
☐ Infection Prevention & Control (IPAC)
☐ ______________________________ ☐ Human Resources
☐ Procurement
☐ Biomedical Engineering
☐ Communications
☐ Manager(s)
☐ Security & Parking
☐ Fire Services
☐ ______________________________

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Feasibility of Recommendations. Consider partnering with families or patients for feedback or review policy changes—future questions and evaluation of outcomes/metrics.

Implementation Summary; Include Leadership & accountability; Proposed Milestones/Targets; Continuous improvement – plan to monitor, adjust, and sustain the recommendation after implementation.

Table 1
Rubric for Critical Appraisal Assignment (20%) + Presentation (5%)
Category Does not meet expectations Meets expectations Exceeds expectations Outstanding

Situation (5/5)
The student will identify chosen policy relevant to nursing practice and the time of the last review. Poor proficiency in describing the situation and the importance of updating this specific policy. Missing sections & citing the chosen policy. Average proficiency at describing the situation of relevance for chosen policy.
Assignments have evidence of synthesis of ideas supporting the relevance of updating the clinical policy selected. Assignment shows strong evidence of synthesis of ideas of selected policy importance to informed practice.
Background
(5/5)
The student will present any relevant history and the policy health topic summary. Wording or writing could be more precise & more organized.
Articulating presenting background to brief and complete.
Need to include a clear summary of policy purpose. Wording or writing is mostly clear, concise, & well-organized. The policy summary is expressed coherently and logically. Language or writing is clear, concise, & well-organized. The policy summary is described in a coherent, & logical manner.
Assessment
(5/5)
The student will report on the current policy areas with emerging literature updates or areas to incorporate cultural safety or patient voices.
Poorly constructed, disorganized, missing information. Ability to articulate and report reviews of literature impacted.
Difficult to follow at times. Average summary of literature relevant to policy. Logical sequence & easy comprehension.
Missing patient voice or input of cultural safety or journal article inclusion incomplete.
Clear, legible & concise inclusion of relevant journal articles with insight to increase cultural safety and patient-centred care.
Recommendation
(5/5) The student will explain what they require, how urgent and when action needs to be taken, and make suggestions of what action(s) is(are) to be taken Fails to provide what is required for policy updates and action needs—little evidence of synthesizing ideas with research.

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Adequate details of requirements and future action needs; some points must be included. Appropriate articulation and explanation of requirements. Straightforward future suggestions and actions are included.
Great ability in articulating and explaining recommendations with supporting evidence.
Presentation
(5/5) Poor constructed, disorganized, missing information. Difficult to follow. Flow is compromised. Adequate presentation of ideas. Logical sequence. Appropriate visual presentation of SBAR. Engaging presentation. Inclusive images & language. Easy comprehension of SBAR.

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CRITICAL APPRAISAL PAPER: UPDATING A POLICY FOR EVIDENCE-INFORMED PRACTICE AND PATIENT-CENTERED CARE

Introduction

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In the ever-evolving field of healthcare, nurses play a crucial role in advancing policy changes to enhance patient care. By staying abreast of practice trends and incorporating new research findings, nurses can contribute to the development of innovative healthcare solutions. This critical appraisal paper aims to explore the process of updating a policy to align with evidence-informed practice and patient-centered care.

Situation: Identifying the Problem and Key Contributors

The chosen policy for this assignment is the "Central Lines Advanced Competency for Nurses: Pediatric (RNs and RPNs)" policy at Kingston General Hospital (Kingston General Hospital, 2014). This policy focuses on the central line dressing changes for pediatric patients. The problem statement revolves around the need to update the policy based on recent research findings and emerging evidence.

Background: Policy Overview and Relevant Setting

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The policy at Kingston General Hospital provides guidelines for nurses working with pediatric patients who require central lines. Central lines are commonly used in critical care units and are associated with the risk of Central Line-Associated Bloodstream Infection (CLABSI) (Wollny et al., 2022). The policy outlines the competencies required by nurses to ensure safe and effective central line care for pediatric patients. It is essential to review and update this policy regularly to align with evidence-informed practice and improve patient outcomes.

Assessment: Incorporating Research and Considerations

To update the policy for evidence-informed practice, a brief literature review was conducted. The search aimed to identify recent research and systematic reviews related to central line care and infection prevention. Cochrane Reviews and other reputable sources were consulted to ensure the inclusion of high-quality evidence (Wollny et al., 2022). The assessment also considered the incorporation of cultural safety and patient input to enhance patient-centered care.

Based on the literature review, two options for policy updates were identified:

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Option #1: Implementation of Bundled Interventions
Pros:

Bundled interventions have been shown to effectively reduce CLABSI rates in pediatric critical care settings (Wollny et al., 2022).
By implementing a bundle of evidence-based practices, nurses can enhance infection prevention and promote patient safety.
Cons:

Implementation may require additional resources, such as staff education and training.
Resistance to change from healthcare providers may pose challenges during the implementation process.
Option #2: Introduction of Real-Time Surveillance Systems
Pros:

Real-time surveillance systems can help identify early signs of infection and allow for prompt intervention.
Continuous monitoring of central line care practices can lead to timely feedback and improvement opportunities.
Cons:

Initial investment in technology and training may be required.
Integration of surveillance systems with existing electronic health record systems may present technical challenges.
Recommendation: Selecting the Preferred Option

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Based on the assessment, it is recommended to implement Option #1: Bundled Interventions. This recommendation is supported by evidence from systematic reviews and offers a comprehensive approach to infection prevention. It is vital to consult with relevant stakeholders, including finance, nursing leadership, and infection prevention and control teams, to ensure the feasibility and successful implementation of the recommended option.

Implementation Summary

To ensure the successful implementation of the recommended policy updates, several milestones and targets need to be established. Leadership accountability should be clearly defined, and regular communication with nursing staff and other healthcare team members should be maintained. Continuous monitoring and evaluation of outcomes will allow for adjustments and improvements as needed. Additionally, incorporating patient and family feedback throughout the process will enhance patient-centered care and contribute to long-term sustainability.

Conclusion

Updating policies for evidence-informed practice and patient-centered care is crucial for enhancing healthcare outcomes. By conducting thorough literature reviews, considering cultural safety, and incorporating patient input, nurses can contribute to policy changes that promote the highest quality of care. Implementing bundled interventions for central line care in pediatric settings is recommended, and careful planning, stakeholder engagement, and continuous monitoring will be essential for successful implementation.

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References:

Kingston General Hospital. (2014). Central Lines Advanced Competency for Nurses: Pediatric (RNs and RPNs) (C-1804). Retrieved from https://kingstonhsc.ca/sites/default/files/uploads/ipo-c-1804_-_central_lines_advanced_compentency_for_nurses_-_pediatric_2014_oct.pdf

Wollny, K., Cui, S., McNeil, D. et al. (2022). Quality improvement interventions to prevent unplanned extubations in pediatric critical care: a systematic review. Systematic Reviews, 11(1), 259. https://doi.org/10.1186/s13643-022-02119-8

Tags: Critical Appraisal Paper, UPDATING A POLICY FOR EVIDENCE-INFORMED PRACTICE AND PATIENT-CENTERED CARE