Implementation into Practice Discussion Paper

Implementation into Practice Discussion Paper

Implementation into Practice Discussion Paper

Regardless of their sizes, missions, and health care programs, health care facilities have a professional mandate to provide timely, safe, and quality care. The standard obligation requires health care facilities to apply multi-dimensional interventions to address patient needs. Research translation into clinical practice promotes evidence-based care and is instrumental in reducing adverse health outcomes through creative problem-solving (Wensing & Grol, 2019). Its significance obliges health care practitioners and organizational leaders to implement programs that reduce gaps between research findings and clinical practice. Accordingly, health care facilities should be open to change and support evidence-based practice (EBP) adequately. The purpose of this paper is to discuss a topic where a gap exists between research findings and their implementation into practice.

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Topic, Supporting Research, and Desired Outcomes

The Agency for Healthcare Research and Quality (AHRQ) explores many health topics relevant to current nursing practice. A topic related to the direct practice improvement (DPI) project is hospital readmissions, represented as a priority for payers, providers, and policymakers striving to improve health outcomes and reduce costs (AHRQ, n.d.). Hospital readmissions connect with the DPI project since their occurrence hampers care quality in the practicum site. Besides, pressure ulcers are a leading cause of hospital readmissions, hospitalizations, and high costs (Wassel et al., 2020). Accordingly, any significant rise in pressure ulcers leads to a proportional increment in hospital readmissions, reducing care quality.

Hospital readmissions adversely affect health outcomes and require evidence-based, sustainable, and relevant solutions. Recent health data shows that over $52.4 billion is spent annually on readmitted patients (Beauvais et al., 2022). Unless health care organizations implement lasting programs, the cost will increase as time advances. Upadhyay et al. (2019) noted that readmission penalties exceed over half a billion dollars annually. Such penalties are detrimental to the growth of organizations and their ability to sustain safe and quality care. Furthermore, crucial aspects of quality sustainability, like organizational reputation and partnerships, become dysfunctional when readmission rates are high in hospitals. Patient-provider relationships are also broken due to reduced patients’ trust in health care professionals.

Pressure ulcers increase the risk of readmissions, and their prevention should be a priority for all hospitals. Research translation into practice implies implementing interventions supported by scientific evidence. Veith et al. (2019) emphasized high attention to wound care, patient education, and modifying risk factors to prevent pressure ulcers. Wound care strategies include preventive dressing, patient repositioning, and wound cleaning for the admitted patients. These strategies are among the core components of a preventive pressure bundle that is highly effective in reducing the incidence of pressure ulcers in critical care settings (Darvall et al., 2018; Hahnel et al., 2020). Implementing such a bundle would be pivotal in reducing readmission rates in the current setting.

Health care professionals implement research into clinical practice to improve health outcomes. The primary goal of implementing research on wound care is to reduce pressure ulcers which will lead to a proportional reduction in hospital readmissions. Reducing readmissions will reduce health care costs and improve the organization’s ability to invest in quality care programs. As Rasiah et al. (2020) mentioned, patients’ trust in health care professionals depends on the care quality and health care experiences. Consequently, implementing a care bundle and other wound care programs will improve patient-provider relationships and patients’ trust in health care professionals. High hospital readmissions hamper organizational reputation (Upadhyay et al., 2019). Implementing research will improve the organization’s reputation and accelerate its growth.

The Extent of Research Implementation

Organizations implement different wound care practices depending on the patients’ type and severity of health conditions. As an established health care institution, ProMedica Skilled Nursing and Rehabilitation (Wheaton) has invested in numerous programs to optimize patient outcomes. They include patient education, telehealth, follow-up care, and testing new treatments and care models (ProMedica, 2021). Despite these programs, the facility primarily relies on routine pressure ulcer prevention care. Overreliance on this care program depicts a huge gap between research findings and implementation into practice, and substantive improvement is essential. More evidence-based interventions should be implemented to reduce the incidence of pressure ulcers among high-risk groups such as the elderly and debilitated patients. Their implementation will reduce the incidence of pressure ulcers and associated adverse outcomes, including hospital readmissions, mortality, and hospitalization.

Possible Barriers to Implementation

Research translation faces multiple barriers depending on the intensity of work required, resources, and the project’s type. Potential barriers to implementing a preventive bundle to prevent pressure ulcers and hospital readmission in the facility include resource facilitation, availability of implementation team members, and patients’ reluctance to participate in the project. Resource inadequacy is a significant barrier since effective research implementation of a care bundle for pressure ulcers requires technologies like patient monitors and alert systems to optimize patient turns. Research also recommends silicone dressing as the most effective preventive dressing for wound care for pressure ulcers (Hahnel et al., 2020). Combining such resources makes the project expensive and inconvenient for timely implementation. The implementation requires teamwork, where the change leader works together with organizational leaders and support nursing staff. However, the intensity of nursing care in the facility would affect their availability and successful research implementation.

Possible Ways to Overcome the Barriers

Success in research translation depends on how change implementers overcome present and emerging barriers. A suitable strategy to overcome the identified barriers is stakeholder engagement. As Haynes et al. (2018) underlined, active stakeholder engagement is crucial to successful change since it influences them positively to support change. The engagement process involves providing stakeholders with adequate information about the research translation and its potential benefits while engaging them throughout the implementation. The other potential intervention is implementing the affordable components of a preventive bundle. For instance, patient repositioning and optimizing turns are affordable and would improve outcomes. Importantly, intensive patient education is crucial to improve health literacy, increase patients’ confidence in the project, and ensure participation and compliance.

Resources Available on the Site

As a modern facility and an affiliate of the extensive ProMedica Health System, ProMedica Skilled Nursing and Rehabilitation (Wheaton) has multiple resources vital in informing the transition from research into practice. They include an equipped health workforce, modality-based equipment, comfortable surroundings, and essentials like the internet (ProMedica Health System, 2022). An equipped and educated health workforce is open to change and readily supports research translation into practice to achieve positive change. Modern equipment and comfortable surroundings are also vital in successful research translation to ensure that research subjects are protected from harm and are comfortable with the process.

Conclusion

Health care facilities should be committed to continuous quality improvement. Such a commitment necessitates continuous research translation into practice and progressive outcomes assessment. Although ProMedica Skilled Nursing and Rehabilitation (Wheaton) has invested in massive programs to improve care quality, more interventions are needed to reduce hospital readmissions. Reducing pressure ulcers will be instrumental in achieving this goal hence implementing research on interventions for pressure ulcer prevention like wound care, patient education, and risk assessment.

References

AHRQ. (n.d.) Hospital readmissions. https://www.ahrq.gov/topics/hospital-readmissions.html

Beauvais, B., Whitaker, Z., Kim, F., & Anderson, B. (2022). Is the hospital value-based purchasing program associated with reduced hospital readmissions?. Journal of Multidisciplinary Healthcare, 15, 1089–1099. https://doi.org/10.2147/JMDH.S358733

Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784

Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621

Haynes, S. C., Rudov, L., Nauman, E., Hendryx, L., Angove, R. S., & Carton, T. (2018). Engaging stakeholders to develop a patient-centered research agenda: Lessons learned from the research action for health network (REACHnet). Medical Care, 56(10 Suppl 1), S27-S32. doi: 10.1097/MLR.0000000000000785

ProMedica. (2021). Your health. Our mission. https://www.promedica.org/redefining-healthcare/#

ProMedica Health System. (2022). ProMedica Skilled Nursing and Rehabilitation. https://www.promedicaskillednursing.org/locations/promedica-skilled-nursing-and-rehabilitation-wheaton/?contentIdString=14063

Rasiah, S., Jaafar, S., Yusof, S., Ponnudurai, G., Chung, K. P. Y., & Amirthalingam, S. D. (2020). A study of the nature and level of trust between patients and healthcare providers, its dimensions and determinants: A scoping review protocol. BMJ Open, 10(1), e028061. http://dx.doi.org/10.1136/bmjopen-2018-028061

Upadhyay, S., Stephenson, A. L., & Smith, D. G. (2019). Readmission rates and their impact on hospital financial performance: A study of Washington Hospitals. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 56, 46958019860386. https://doi.org/10.1177/0046958019860386

Veith, J. P., Collier, W., Kim, J., Agarwal, J., & Kwok, A. (2019). A national analysis of readmissions for wound healing complications following the repair of lower back, hip, and buttock pressure ulcers using the Nationwide Readmissions Database. The American Journal of Surgery, 217(4), 658-663. https://doi.org/10.1016/j.amjsurg.2018.12.013

Wassel, C. L., Delhougne, G., Gayle, J. A., Dreyfus, J., & Larson, B. (2020). Risk of readmissions, mortality, and hospital‐acquired conditions across hospital‐acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. International Wound Journal, 17(6), 1924-1934. https://doi.org/10.1111/iwj.13482

Wensing, M., & Grol, R. (2019). Knowledge translation in health: How implementation science could contribute more. BMC Medicine, 17(1), 1-6. https://doi.org/10.1186/s12916-019-1322-9

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Assessment Description
The purpose of this assignment is to critically appraise a gap between research findings and the implementation of those findings into practice.

In 2009, upon noticing a dearth of evidence-based decisions in health care settings, the Institute of Medicine (IOM) set a goal to substantially increase the number of clinical decisions supported by timely and relevant evidence over the following decade. Bridging the gap between research findings and practice implementation was a key strategy the IOM utilized to make this goal more achievable. Relying on the best evidence allows health care practitioners to deliver quality and appropriate patient care while helping to improve the nation’s health.

General Requirements:

Use the following information to ensure successful completion of the assignment:

Review the Agency for Healthcare Research and Quality (AHRQ) website to complete the assignment.
Use at least two additional scholarly research sources published within the last 5 years. Provide citations and references for all sources used.
Doctoral learners are required to use the current APA style for their essay writing assignments. The current APA Style Guide is located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Directions:

On the Agency for Healthcare Research and Quality (AHRQ) website, select a topic either related to your DPI Project or aligned with the type of project you are exploring. Select a specific topic where there exists a gap between research findings and the implementation of those findings into practice. In a 1,000-1,250-word paper, address the following:

Introduce the topic, present supporting research findings, and discuss the desired outcomes of putting that research into practice.
Assess to what extent the practice is being implemented.
Evaluate possible barriers to implementation into practice.
Propose ways to overcome the barriers.
Discuss the resources available on the selected site to inform the transition from research into practice.

Implementation Into Practice – Rubric
Rubric Criteria
Total
100 points
Criterion

1. Unsatisfactory

2. Less Than Satisfactory

3. Satisfactory

4. Good

5. Excellent

Extent of Practice Implementation

Extent of Practice Implementation

0 points

Assessment of the extent to which the practice is being implemented is not included.

11.2 points

Assessment of the extent to which the practice is being implemented is partially incorporated, but the information provided is incomplete, inaccurate, or otherwise deficient.

12.32 points

Assessment of the extent to which the practice is being implemented is present, but minimal detail or support is provided.

12.88 points

Assessment of the extent to which the practice is being implemented is provided with appropriate details and support.

14 points

Assessment of the extent to which the practice is being implemented is thoroughly explored and clearly explained with relevant details and support.

Paper Format (use of appropriate style for the major and assignment)

Paper Format (use of appropriate style for the major and assignment)

0 points

Template is not used appropriately, or documentation format is rarely followed correctly.

6.4 points

Template is used, but some elements are missing or mistaken; lack of control with formatting is apparent.

7.04 points

Template is used, and formatting is correct, although some minor errors may be present.

7.36 points

Template is fully used; There are virtually no errors in formatting style.

8 points

All format elements are correct.

Thesis Development and Purpose

Thesis Development and Purpose

0 points

Paper lacks any discernible overall purpose or organizing claim.

4 points

Thesis is insufficiently developed or vague. Purpose is not clear.

4.4 points

Thesis is apparent and appropriate to purpose.

4.6 points

Thesis is clear and forecasts the development of the paper. Thesis is descriptive and reflective of the arguments and appropriate to the purpose.

5 points

Thesis is comprehensive and contains the essence of the paper. Thesis statement makes the purpose of the paper clear.

Evaluation of Possible Barriers to Implementation

Evaluation of Possible Barriers to Implementation

0 points

Evaluation of possible barriers to the implementation into practice is not included.

11.2 points

Evaluation of possible barriers to the implementation into practice is partially incorporated, but the information provided is incomplete, inaccurate, or otherwise deficient.

12.32 points

Evaluation of possible barriers to the implementation into practice is present, but minimal detail or support is provided.

12.88 points

Evaluation of possible barriers to the implementation into practice is provided with appropriate details and support.

14 points

Evaluation of possible barriers to the implementation into practice is thoroughly explored and clearly explained with relevant details and support.

Introduction of Topic, Research Findings, and Desired Outcomes

Introduction of Topic, Research Findings, and Desired Outcomes

0 points

Introduction of the topic, supporting research findings, and desired outcomes of putting research into practice is not included.

11.2 points

Introduction of the topic, supporting research findings, and desired outcomes of putting research into practice is partially incorporated, but the information provided is incomplete, inaccurate, or otherwise deficient.

12.32 points

Introduction of the topic, supporting research findings, and desired outcomes of putting research into practice is present, but minimal detail or support is provided.

12.88 points

Introduction of the topic, supporting research findings, and desired outcomes of putting research into practice is provided with appropriate details and support.

14 points

Introduction of the topic, supporting research findings, and desired outcomes of putting research into practice is thoroughly explored and clearly explained with relevant details and support.

Available Resources

Available Resources

0 points

Discussion of the resources available on the selected site to inform the translation from research into practice is not included.

11.2 points

Discussion of the resources available on the selected site to inform the translation from research into practice is partially incorporated, but the information provided is incomplete, inaccurate, or otherwise deficient.

12.32 points

Discussion of the resources available on the selected site to inform the translation from research into practice is present, but minimal detail or support is provided.

12.88 points

Discussion of the resources available on the selected site to inform the translation from research into practice is provided with appropriate details and support.

14 points

Discussion of the resources available on the selected site to inform the translation from research into practice is thoroughly explored and clearly explained with relevant details and support.

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to as

Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)

0 points

Sources are not documented.

5.6 points

Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.

6.16 points

Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.

6.44 points

Sources are documented, as appropriate to assignment and style, and format is mostly correct.

7 points

Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

Mechanics of Writing (includes spelling, punctuation, grammar, language use)

0 points

Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.

4 points

Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register) or word choice are present. Sentence structure is correct but not varied.

4.4 points

Some mechanical errors or typos are present, but they are not overly distracting to the reader. Correct and varied sentence structure and audience-appropriate language are employed.

4.6 points

Prose is largely free of mechanical errors, although a few may be present. The writer uses a variety of effective sentence structures and figures of speech.

5 points

Writer is clearly in command of standard, written, academic English.

Proposal for Overcoming Barriers

Proposal for Overcoming Barriers

0 points

Proposed ways to overcome possible barriers to implementation into practice are not included.

11.2 points

Proposed ways to overcome possible barriers to implementation into practice are partially incorporated, but the information provided is incomplete, inaccurate, or otherwise deficient.

12.32 points

Proposed ways to overcome possible barriers to implementation into practice are present, but minimal detail or support is provided.

12.88 points

Proposed ways to overcome possible barriers to implementation into practice are provided with appropriate details and support.

14 points

Proposed ways to overcome possible barriers to implementation into practice are thoroughly explored and clearly explained with relevant details and support.

Argument Logic and Construction

Argument Logic and Construction

0 points

Statement of purpose is not justified by the conclusion. The conclusion does not support the claim made. Argument is incoherent and uses noncredible sources.

4 points

Sufficient justification of claims is lacking. Argument lacks consistent unity. There are obvious flaws in the logic. Some sources have questionable credibility.

4.4 points

Argument is orderly but may have a few inconsistencies. The argument presents minimal justification of claims. Argument logically, but not thoroughly, supports the purpose. Sources used are credible. Introduction and conclusion bracket the thesis.

4.6 points

Argument shows logical progressions. Techniques of argumentation are evident. There is a smooth progression of claims from introduction to conclusion. Most sources are authoritative.

5 points

Clear and convincing argument that presents a persuasive claim in a distinctive and compelling manner. All sources are authoritative.