Evidence Based Practice Free Essays

string(76) " questions subsequently formulated and asked, and the interventions chosen\." A CRITICALLY REFLECTIVE APPROACH TO EVIDENCE-BASED PRACTICE A Sample of School Social Workers Michelle Bates Definitions of EBP The first type of definition implies that practitioners are recipients of existing research knowledge. These definitions of evidence-based practice represent a deterministic, prescriptive approach to practice. According to these definitions, knowledge is created by researchers, and handed to practitioners to be applied in practice situations. We will write a custom essay sample on Evidence Based Practice or any similar topic only for you Order Now The second type of definition suggests that practitioners investigate practiceproblems, and assess research in accordance with their clinical judgment and then, thirdly, collaborate with their clients Some authors define evidence-based practice with a focus not on the research, but rather on the practitioner; on her or his professional judgment, skills, and knowledge acquisition processes. These distinctions regarding the evidence and the role of the practitioner, are but one area of debate concerning evidence-based practice. vidence-based practice generally understood effort to direct practitioners to base their interventions upon formal research, promising benefits to both clients and practitioners. Emergence of EBP in Social Work * During the empirical practice movement questions about the credibility, effectiveness, and efficacy of social work have been raised. EBP emphasizes science, and, by lessening reliance on professional judgment; offers a sense of certainty about social work interventions. Some authors suggest that evidence-based practice in particular is tied to neo-liberalism. In this context, evidence-based practice ensures that social workers provide high-quality services effectively * The public’s reluctance to accept social work’s authority has forced social work, like many other professions, to adopt evidence-based practice as a new mechanism of trust Beginning in the 1990s, public cynicism concerning the welfare state and â€Å"expert systems† led many to doubt the validity of social work interventions * Government cutbacks and a demand from funding bodies for accountability and efficiency have also necessitated the adoption and implementation of evidence-based practice. Quality and accountability have become the watchwords of health and mental health services† Governments and agencies embraced evidence-based practice as a method of ensuring quality services and demonstrating accountability in service delivery The Promises of EBP for Clients and Social Workers Promises made by proponents of evidence-based practice are numerous. Supporters of EBP claim that clients will receive better services, occupy a more egalitarian position, and are less likely to be harmed when practitioners use evidence-based practices. For social workers themselves, protection from lawsuits, enhanced job security and service funding, increased professional confidence, and improved professional status and credibility are promises associated with evidence-based practices. Many authors argue that reliance on research evidence leads to better decision-making by social work practitioners and, results in, improved services. It is also claimed that clients, able themselves to access the ‘evidence’, will achieve greater equity with professionals. Numerous authors assert that EBP is the most ethical way to practice. Gambrill (2003), in her support of EBP, suggests that social work practice that is not evidence-based may potentially be harmful to clients Barriers to Using Evidence For some other authors * Despite an increasingly available literature concerning evidence-based practice, dissemination studies reveal that social work practitioners have been neither accessing nor implementing the available evidence * For some, EBP remains overwhelming, unclear, or irrelevant * Barriers to the implementation of evidence-based practice include social workers’ doubts about the applicability of research findings to practice settings questions about practitioners’ ability to read and interpret research findings * practitioners’ scepticism about research specifically * their reluctance to change generally, practitioners’ lack of time to review the literature * ideological debates about the nature of social work and its incompatibility with positivist research * Applicability of Research Findings to Practice Settings; There is a significant disconnect between treatments established in the laboratory and the everyday use of these treatments Practitioners, keenly aware of this discrepancy, have been suspicious of evidence-based practices The Research In the absence of literature from practicing social work practitioners, this research sought to discover and understand their opinions and experiences with evidence-based practice. School social workers are an especially appropriate focus of attention because 1- They are practicing in environments that emphasize effective service delivery with improved service outcomes. 2- Additionally, EBP is endorsed as a practice framework by many Ontario School Boards and school social work practice associations Methods qualitative research project; semi-structured interview * Social workers were asked for their definition of evidence-based practice, what they either liked or disliked about EBP, what influenced them to either use or not use EBP, and what were the challenges, risks or gains in either using or not using EBP for themselves, their department or the profession. * total of four practicing school social workers participated in the research project that entailed face-to-face interviews lasting between 1-1. hours * All participants held MSW degrees and RSW designations. * Two of the social workers were employed by Catholic school boards and the other two by public school boards. * All of the participants worked within urban school settings in cities that ranged in size from 200,000 to 500,000 people * One social worker worked within a fairly affluent and culturally homogeneous community, and the remaining three in schools that represented economically and culturally diverse communities. One participant was a manager, and the remaining three participants were front-line practitioners. * Participants ranged in their years of experience as a school social worker from 2 years to 21 years. * Participants’ experiences with evidence-based practice varied. Two participants were extremely familiar with evidence-based practice, and the other two participants knew about it, and described themselves as having a beginning understanding of what it meant. Their employers’ organizational embrace of evidence-based practice varied as well. One board was silent, two were in the early stages of investigating it and one Board has endorsed the use of evidence-based practices wholly. Findings A. Benefits of using evidence-based practice as prescribed: Several benefits emerged from the participants’ experiences of using evidence-based practice â€Å"as prescribed. † 1- Every participant identified how evidence-based practices usefully informed and guided their activities with individual clients. These activities included the issues or problems that social workers explored, the questions subsequently formulated and asked, and the interventions chosen. You read "Evidence Based Practice" in category "Papers" 2- Evidence-based practices were also used to guide the selection of group models and various protocols, as noted by two of the social workers. 3- All participants indicated that using evidence-based practices provided them with a sense of certainty about their own practice. 4- Three of the four participants specifically stated their desire to know that what they did made a difference to clients. Using evidence-based practice was perceived as a means of ensuring that the interventions they were providing were effective 5- All participants indicated that using evidence-based practice improved their professional credibility. 6- The other two social workers believed that using evidence-based practices would improve the profile of their department within the school board and would also create a higher profile and better public persona for all social workers. B. Tensions arising from the use of evidence-based practices as prescribed 1- Rigidity versus flexibility : Ensuring that their interventions fit for clients was an overriding concern for all of the participants, and was expressed as a tension between implementing rigid evidence based practices versus the need to be flexible with clients based upon the uniqueness of each individual client and his or her situation. Three of the four participants were also cognizant of the fit, or lack of it, of evidence-based practices with their organizations or settings 2- Formal knowledge versus practice knowledge : All of the participants made a distinction between formal knowledge and their practice knowledge. Each one of them revealed a tension between these two kinds of knowledge and all of them talked about valuing their own practice knowledge. Despite the benefits they identified of using formal knowledge derived from evidence-based practice, these participants continued to believe in the value of their practice knowledge. The tension between formal knowledge and practice knowledge is reflected in this social worker’s comment: â€Å"I would hate to become so single-minded that I’m sitting in a meeting saying, ‘well, based on the evidence that†¦. ‘ So I use both [practice and formal knowledge], and I’m not apologetic that I use both. † Not only did all of the participants in this study use both kinds of knowledge; they resoundingly claimed the value of their practice knowledge. – Results versus improvement and change : All of the participants were keenly aware of their desire to know the results of their interventions with clients, and hinted at the pressures they felt to be producing changes for their clients. In other words how clients perceive their gains is more meaningful than what would be reflected according to a particular measure or assessment instrument. Three of the four participants were steadfast in their acceptance of their clients’ definitions of improvement and change, rather than relying on pre-determined outcomes. – Method/technique versus relationship : Every participant noted that the relationship with the client was more important than the particular technique use. Only in the context of a meaningful relationship with clients could evidence-based practices be shared and used meaningfully. In other words, the relationship provides the context in which evidence-based information can be shared and used meaningfully. 5- Adapting evidence and evidence-based practice : participants revealed how they are using evidence and evidence-based practices in adaptive and creative ways. This has led to a redefining of evidence and the uses of evidence-based practice for school social workers. 6- Adaptations to local context: Much often evidence-based practice literature sees it as problematic that front-line practitioners alter evidence-based practices when they implement them into practice settings. Contrary to the literature, every one of these practitioners saw adaptations to the local context as not only a necessity, but also an asset. – Redefining Evidence: Information from these participants indicates that they have a broad definition of evidence-based practice that incorporates evidence from a wide variety of sources, including their practice experience. As noted in the literature review, there are numerous definitions of evidence-based practice that reflect either a dependency upon formal research, or suggest that evidence based practice is a process of knowledge acquisition. These social workers conceptualize evidence in its broadest sense, and as a result, their definitions, and their practice based upon those definitions, represent a de-mystifying of evidence as it is constructed in the dominant discourse on evidence based practice. 8- Evidence and evidence-based practice as power : The various social, economic and political contexts that have give rise to the emergence of evidence-based practices have created a powerful paradigm, a political economy of evidence-based practice. Interestingly, all research participants talked about their different uses of evidence and evidence-based practice within different contexts. In this way, social workers are negotiating power through their definition of evidence, and their strategic use of both evidence-based practice and the language of EBP. One of participant’ definition of evidence holds different currency with different audiences. Within organizational structures that are determining funding and service levels, formal knowledge is seen as more reliable and valid therefore, the language of evidence-based practice is used to provide proof or support of the request for continued or additional service. From the data, social workers have indicated that they use the language and power of evidence-based practice to meet a variety of needs. all participants noted how the language of evidence-based practice was used to provide proof of the value of social work services. Because school social work is offered within a secondary setting, participants were acutely aware of the need to prove the value of their service and how it supports the goals of the school board to retain students in school and to improve their academic achievement. Discussion and implications 1- Much of the mainstream EBP literature suggests that social workers have been ambivalent or reluctant to adopt evidence-based practices due to limitations of their skills, time and resources, or their beliefs and attitudes. This study, however, in keeping with important critiques of EBP, confirms that social workers identify important tensions between the dominant discourse of EBP and social work practice values. 2- A key tension for social workers centred on the value placed upon formal knowledge versus practice knowledge. This is reflected in the epistemological debate concerning the definition of evidence. The discourse on evidence-based practice is situated within a narrow, prescriptive, and scientifically defined construct about what constitutes evidence and how that evidence should be used. Evidence-based practice has been criticized for minimizing practitioner knowledge. As Holloway (2001) observed, evidence-based practice, â€Å"imposes a paradigm for what counts as legitimate evidence that is external to the practices and ways of knowing of the many professionals† Within the paradigm of evidence-based practice, the definition of evidence is crucial to understanding what kinds of knowledge are accepted and valued, and what kinds of knowledge are dismissed. The evidence-based paradigm further means that certain treatments are endorsed as evidence-based, and others are not. Social workers in this study believed in, relied upon, and valued their practice knowledge, when the literature was absent on the practice issue, when they were applyingthe evidence-based literature and when their knowledge was contrary to the literature. 3- Social workers in this study also described the tension they felt between rigid adherence to manualized protocols required of evidence-based practices and the need to be flexible in response to their individual clients’ needs. This tension is reflected in the critiques of the evidence-based practice research. Many authors have been critical of the artificial results created within highly controlled laboratory settings. 4- Evidence-based practice has also been criticized for ignoring and negating the nature of social work practice. Social workers interviewed in this study consistent with critiques of EBP, the problem with the current discourse of evidence-based practice is that it reduces understanding of the complexity of human experience in the real world, ignores the realities of practice settings, and negates the practice knowledge of social workers. – Social workers also revealed how they negotiate power through their definition of evidence, and their subsequent strategic and creative use of both evidence-based practice and the language of EBP. Social workers use the language and persuasive discourse of EBP with management and funding bodies to provide accountability for services provided, proof of the value of social work services, and rationales for continued or increased service levels. With colleagues, using the language of EBP provides the practitioner with the voice of authority. – The literature on evidence-based practice often advocates either for or against EBP. Interestingly, this research shows how social work practitioners can simultaneously appreciate and benefit from EBP while also questioning and adapting it. 7- School social workers from this study value both formal and informal knowledge, and creatively use their different kinds of knowledge in different contexts 8- Data from this research project identifies how social workers are cultural bridges between the research and practice worlds, two vastly different kinds of evidence, and two different uses of evidence-based practice. The divide between researchers and practitioners has a long history in social work. And while there have been pleas to respect each other in order to effectively learn from each other researchers, especially within the evidence-based discourse have enjoyed a higher status than practitioners. What this research highlights is that practitioner knowledge is highly valuable knowledge, and should be regarded as such by researchers. This research also implies that social work practitioners can make valuable contributions to research projects by ensuring that the research is relevant to clients and practitioners by focusing on client needs/experience and insisting that the research takes place in the real world under real life practice conditions. How to cite Evidence Based Practice, Papers Evidence Based Practice Free Essays string(70) " is not given efficiently enough when a patient complains about pain\." Change Management Contents Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 3 Evidence Based Practice†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 4 Clinical Governance†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 5-6 Findings from the literature†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦6-7 Implementing the change†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦7-9 Leadership†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. We will write a custom essay sample on Evidence Based Practice or any similar topic only for you Order Now 9-10 The Un-freezing Stage†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦10-11 The Moving Stage†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11-13 The Re-freezing Stage†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 13-15 Resistance and barriers to change†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 15-16 Conclusion†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 16-17 References†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 18-24 Appendices†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5-26 Introduction This is essay is being written to identify and promote change in clinical practice in relation to nursing and evidence based practice. This will be done in relation to nursing and will include supporting references. The literature review investigated nurses’ knowledge of pain management, finding that nurses’ had different ideas of what pain management is. Therefore the aim of the essay is to change practice by increasing nurses’ awareness of what exactly pain management is and from this how it can improve postoperative pain management in the clinical area. This essay commences with a description of both clinical governance and evidence based practice (EBP) and the association between them, describing how this will assist achievement of clinical effectiveness. From this there will be a synopsis of the findings from a recent literature review of â€Å"Nurse Assessment and Management of Postoperative Pain† including a recommendation that was found from the evidence of this review and how this will have an impact for a change in practice. An analysis of different theories of change will be made, looking at several models and theorists. The chosen model for change will be used to bring the findings from the review into practice and what resources will be needed for the implementation of change and any barriers that may occur during the change process. All names and locations will be changed to maintain confidentiality in accordance with the Nursing and Midwifery Council (NMC) Code of Conduct (2008). Evidence Based Practice Evidence-based practice has been described as a systematic process of ‘finding, appraising and using research findings as the basis for clinical decisions’ (Long and Harrison, 1996 cited in McSherry et al, 2002, p7). However there are many other definitions the most widely used is Sackett et al (1996) â€Å"The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. † However there are some problems with this definition especially with regards to nursing. This definition does not include what the patient wants from the care given. Morton and Morton (2003) agree that patients should be involved in decisions about their care. Therefore there is an alternate definition more suited to nursing that states â€Å"an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best† (Muir Gray, 1997). Simmons (2002) supports this view and states that for research to be of benefit it needs to be individualised to the patient. According to Morton and Morton (2003) this definition highlights that the nurse should integrate the patients preferences and their wish to avoid risk associated with some interventions and using the best available evidence for said interventions. More recently, Gerrish et al (2010) suggests that for nurses to give the best possible care to patients they need to research the evidence available and apply it to their decision-making in clinical practice. Clinical Governance Clinical Governance is an umbrella term that covers activities that help sustain and improve high standards of patient care. It is how health services are held accountable for the safety, quality and effectiveness of clinical care delivered to patients (NHS Scotland, 2007) Clinical Governance was introduced in response to public concerns over poor standards of care provided by the National Health Service (NHS) (Wright and Hill, 2003). There are seven pillars of Clinical Governance including 1. Risk Assessment 2. Clinical Effectiveness 3. Education, Training and Continuing Personal Development 4. Use of Information 5. Staffing and Staff Management 6. Clinical Audit 7. Patient/Service User and Public Involvement To monitor standards of clinical governance the government established the National Institute for Clinical Excellence (NICE) and commission for Health Improvement (CHI) (Department of Health, 1998). The purpose of clinical effectiveness is using the best available knowledge through research, clinical expertise and patient choice, applied to patient care. This can be achieved through training, education and change management (Muir Gray, 2001); evaluated through clinical guidelines and provision of evidence-based practice (Royal College of Nursing, 1996). Clinical effectiveness is the cornerstone of evidence-based practice’ (Reagan, 1998 p245) Links between evidence based practice and clinical effectiveness are outlined by Dawson (2001). He suggests that evidence based practice cannot be achieved independently of clinical effectiveness. McSherry et al (2002) considered that the two are interdependent of each other with evidence being used to improve practice and enhance effectiv eness of care. Findings from the literature The findings from the literature review suggest that pain management is not being implemented as well as it should be in the postoperative setting. Nurses’ should be working within the NHS Enhanced Recovery Programme (2008). However findings from the review have proven that assessments are not good enough or consistent throughout wards in the same hospitals. The evidence proves that self-reporting of pain was not seen as a vital part of assessment. Carlson (2009) shows that only 59% of registered nurses accepted patients report as valid assessment of pain although it is Gold Standard for pain assessment (Melzack and Katz 1994). Another study (Rejeh et al 2008) showed that nurses are too busy with such a large workload to be able to do full pain assessments on their patients. Young et al (2006) believes that a good assessment tool will help efficiently assess pain. According to The World health Organisation (Delphi, 2007) nurses can first evaluate the pain and can recommend to the treating doctor whether the use of pain relief medication is appropriate. However Cordts et al (2011) suggest that doctors are not listening to nurses’ assessments of the patient and this can lead to the patient not moving up a step on the WHO Pain Ladder. Medication is not given efficiently enough when a patient complains about pain. You read "Evidence Based Practice" in category "Papers" Doctors can be slow to prescribe, as they do not see it as urgency. Doctors then need to understand that analgesics need to be given promptly as to stop any further discomfort for the patient. All of the above findings lead to the main theme that was evident throughout the literature – A lack of nurse knowledge and pain education. Carlson 2009, Chung et al 2003, Coll and Ameen 2006 all show that there is a high awareness of pain from registered nurses but there is a low level of consistent implementation of evidence based practice when it comes to pain management. Carlson (2009) results showed that nurses were not transferring their knowledge into clinical practice. Nurses deliver the majority of patient care (WHO, 2007) and have an ethical and moral responsibility to ensure that best care is provided by incorporating Evidence Based Practice into clinical practice (NMC, 2011) Therefore in this assignment the proposed change will concentrate on the improvement of nurses’ knowledge of post-operative pain management in accordance with the NHS Institute for Innovation and Improvement Enhanced Recovery Programme (2008, See Appendix A). This will be guided by an educational session to implement this change. Implementing the change According to Sale (2005) change needs to occur to improve patient care. However change is best if it is planned. Cork suggests that if it is to be successful it needs to be planned, focused and inclusive. Pearce (2007) McAuliffe and Vaerenbergh (2006), Craig et al (2008), Upton (2005) all agree that barriers will arise if a change is unplanned, or if nurses are unaware of it. Change needs to be well communicated and organised with everyone who will be involved (Upton, 2005). To enable change, the type of change needs to be recognised. Planned change is considered and put into practice by a well-informed agent and triggered by the need to respond to new challenges, opportunities or potential complications (Thornhill et al, 2000) McSherry and Pearce (pg. 128, 2007) suggest that Change is complex and that barriers are inevitable therefore threatening the successful implementation of clinical governance. It is suggested then that utilising a change model can help guide the process and hopefully reduce the obstacles, which may be encountered. There are a number of questions that need to be looked at before a change can commence (Craig et al 2008). Firstly, will the patient benefit from the proposed change? For the proposal of an educational programme to improve nurse knowledge then yes, the patient will benefit. As they will be treated in accordance with NHS evidence based guidelines. The next step is choosing a change management theory to follow stage by stage. There are many change theories, some of which are easier to follow than others (Sale, 2005). It is important that the correct theory is chosen because if the wrong one is picked it can lead to negative outcomes for the proposed change. (Craig et al, 2008). The change theories that will be discussed are Lewin’s Force Field theory (1953) and Lippitt et al (1958). Lewin’s theory has three steps; Un-freezing which allows existing processes to change. Movement allows adoption of new practices and Re-freezing, which involves re-stabilisation; ensuring practices remain in the organisation (Gopee and Galloway 2009 and Mullins 2010). His theory also places emphasis on the driving and resisting forces associated with any change, and to achieve success the importance lies with ensuring that driving forces outweigh resisting forces (Baulcomb, 2003). When driving forces exceed restraining forces, the move towards change is facilitated (Reid, 2002). Lippitt’s (1958) is an extension of Lewin’s (1951) Force Field theory. It is a seven-step theory, where information is constantly exchanged. This is advantageous as communication is key if a change is to be made in clinical practice (Mcsherry and Pierce, 2007). However, the focal point of this theory is the role and responsibility of the change agent. Although this is important there is not an emphasis on the progression of change that Lewin’s 1951) theory has. Lewin’s (1951) force field analysis will enable participants in this change process to identify factors that are driving the change and those causing resistance (Gopee and Galloway, 2009) Lewin’s theory (1951) will be implemented as this helps to understand planned change processes within organisations. The three steps should be followed to create and embed change. Leadership To bring about cha nge in the clinical area it is important to have good leadership. According to Allen (2000) having a good leader will improve patient care. Lewin (1951) says that it is necessary to have a change agent in order for the change process to be effective. A change agent is a person who is organises and holds the day-to-day responsibilities of the change (Craig et al, 2008). McSherry and Pierce (2007) believe that the change agent needs to have certain characteristics to be an effective leader. They need to have self-belief, self-awareness, drive for improvement and personal integrity. Another key component of a successful change agent is one who has excellent communication skills. McSherry and Pierce (2007) discuss that communication can be enhanced in the clinical environment by sharing goals, information, learning and responsibilities so that everyone feels included in the change. Baulcomb (2003) agrees with this stating that the change agent needs to empower the staff giving them a chance to enhance their skills. However on the other hand Cherry et al (2005) believes that the change agent needs to be original, be able to analyse the evidence-based practice and collect and implement the change along with possession of a positive outlook. This would improve nurses’ pain management knowledge with the implementation of the NHS Enhanced Recovery Programme (2008). For this change to come about the change agent needs to have as many of positive characteristics stated above. The more of them that they have the more likely it will be that the change will be implemented with fewer barriers in the process. (McSherry and Pierce, 2007). The change agent for this project will need to be able to communicate with theatre, recovery and ward managers. Bass (1985) extended on the work of Burns (1973) about transformational leadership. He suggests that the followers of a transformational leader feel trust, admiration and loyalty for them. They make them feel this by inspiring them and give them their own identity (Kotlyar and Karakowsky, 2007). Using such an approach will reduce the resistant forces by bringing about change slowly to clinical practice (Sale, 2005). The Unfreezing Stage Lewin’s first stage in the change process is Unfreezing. Recognition that change needs to be made is the initial step. From this the right conditions for change to occur are developed and the forces maintaining behaviour reduced (Gopee and Galloway, 2009 and Mullins, 2010). The literature review states that nurses were unclear about what pain management was and how any knowledge they had of it could be brought into practice (Carlson 2009, Chung et al 2003, Coll and Ameen 2006). Nurses need to be educated on the importance of pain, good communication and assessment skills to a more in depth level than what is taught during university. For nurses to use the NHS Enhanced Recovery Programme, forces are needed to direct the behaviour away from the original situation and drive them towards the proposed change (Robbins 2003). To achieve this change in practice the change agent would need to have posters and leaflets produced so that staff know that there is a proposed change. This way when initial meetings are called they will not be surprised and they will have already formed opinions and hopefully ideas to bring to the table. Within the leaflets there will be evidence from the literature review of what needs to be changed how the change will be implemented. The posters will include a diagram of the tool that is to be introduced and how this will improve care for post-operative patients. During this stage the change agent will need to communicate with all the stakeholders this includes the nurses at ward level but also the ward manager, as she/he will hopefully be able to fund any expenses. Printing and photocopying charges will apply as well as a room within the hospital will need to organised at this stage, to ensure that it will be vacant. Resistance will begin to show at this stage. Sullivan (1992) states that it is then the change agents’ responsibility to earn the resistors trust and respect by the use of effective communication and understanding. Robin (2003) states that the percentage of driving forces needs to be higher than those opposing the change in order to unfreeze the current state. The nurses on the post-operative ward will now be able to trial use the enhanced recovery programme (2008) and put forward their opinions to the change agent, be it ideas to improve the proposed change or reasons why they do not want or like it. The Moving Stage The second stage identified by Lewin’s change process is Movement. This is the transition from the present to stage to the chosen stage (Lewin, 1951). It requires bringing equilibrium back, which has been broken in the unfreezing stage. Sale (2005) states that if the change agent has been effective in preparing for the change in the first stage nurses should begin to accept it. Sale (2005) also explains that this stage identifies the roles and responsibilities within the change to the nursing team, which is needed for the change to take place. The leaflets that will be circulated will include definitions of clinical terms including †What is pain management†, information about the Pain Ladder and the Enhanced Recovery Programme (2008). There will be opportunities during handovers if anyone does not fully understand anything within the leaflet. Stakeholders will be required to sign to say that the booklet has been read and understood. National Institute for Clinical Excellence (NICE) suggests that printed materials are low cost aids to raise awareness of a desired change, and most importantly are very effective in changing behaviour especially when combined with other methods. After all the signatures have been collected informal teaching sessions of half an hour will commence and will be facilitated by the change agent to re-educate and influence the stakeholders targeted in the change process. This will be achieved using a normative re-educative approach. This approach addresses group norms, personal values and common goals. The stakeholders internalises the change rather than imposing change through authority and coercion. However these sessions will be made compulsory by authorities in order to promote best practice. The idea of these sessions is to aid in clearing any confusion about what has been read in the leaflets, increasing nurses’ knowledge and allowing stakeholders an understanding of the merits of change (Dawson 2001). It would be helpful to have the pain specialist nurse attend he sessions, it would hopefully make the staff aware of how important the change will make to the patients. Dowsett (2001) states that professional development is a key element to provision of clinical government. Learning not only provides nurses with knowledge and skills, it improves competence and reduces threat to change (Chapman and Howkins, 2001). It is vital that the chang e agent considers available resources. A lack of resources is a barrier to the implementation of evidence-based practice and therefore the implementation of clinical effectiveness (Polit and Beck, 2001). Appendix B summarises the time, cost and resource requirements for each activity, for the implementation of the educational package. This will assist nurses in the improvement of post-operative pain management using best evidence. The table in Appendix B provides a brief summary of the activities required to bring about change, the time it takes to start activity, how long it will take to implement action, cost and resources required to ensure implementation of change and change management. The cost and timelines are an estimation, which needs to be taken into consideration. The prices of stationary that have been included are given at institutional rates. The venue for the half hour re-education session will be allowed in the day room on the ward as management has made arrangements for this. The change agent will need to clarify that the Health Board would give 100% funding to the proposed change. Training is compulsory for practitioners in order to meet statutory obligations. According Aneurin Bevan Health Board (2010) training designated as mandatory meets the needs of the service. The Re-freezing Stage The final stage identified by lewin’s (1951) change process is re-freezing, which comes with proper implementation of the change. According to Gopee and Galloway (2009) the change agent will need to maintain motivation throughout implementation and ensure that change is integrated and assimilated by the organisation and stakeholders. Gopee and Galloway (2009) also agree with Bednash (2003) state change is needed within the nursing profession to provide quality care. Nurses need to monitor quality of care given by recognising problems and from this implement best practice (Grol and Grimshaw, 2003). If this stage is not done then there is a high chance that nurses will revert back to the original state (Robbin, 2003). It is in this stage that it necessary to bring in formalities such as guidelines and policies. This will ensure that Lewin’s (1951) Re-freezing stage is implemented. This stage also ensures that the stakeholders approve of the change. McSherry and Pierce (2007) explain that once the stakeholders have accepted the introduction of the Enhanced Recovery Programme (2008) there will be no more resistance or barriers and the stakeholders will have accepted the new change. To evaluate the effectiveness of the change, the next step would be to introduce clinical audit to compare with previous outcomes of post-operative pain management or, more importantly how to keep preventing poor pain management. NICE (2002) states that an audit is a quality improvement process, aiming for enhancement of patient care, during an assessment of care. This will be introduced in another session based on the ward, three months after the change. A questionnaire would be introduced to get feedback from practice (NICE, 2007). The results from this would be anonymous as to not compromise levels of knowledge. Bell and Duffy (2009) state that clinical audit are used as a way to improve assessment and management of pain and to assure that best practice is applied in clinical practice. The department of health (1989) explains that audit helps to underline variation in practice, giving opportunity practitioners to reflect and evaluate the success of implementation. Three months after the first another audit will be carried out to ensure that the change has become frozen and that it is making the improvements that were needed within clinical practice. The change agent will need to release the results of clinical audit of the Enhanced Recovery Programme (2008) to all involved and to other wards so that the change can be implemented else where if requested (Murphey, 2006). Any new evidence that develops that will improve best practice will be highlighted in yearly update teaching sessions. Resistance and Barriers to Change NICE (2007) states that in order to develop a successful strategy for change; the change agent needs to understand barriers faced within health care organisations. Gopee and Galloway (2009) suggest that change can cause anxiety; resistance to change can succeed as a result of fear of the unknown: lack of confidence of knowledge or skills to carry out the change. However parkin (2009) states that change can be disturbing to those involved therefore resulting in increasing resistance to the implementation of a change. It is therefore the change agent’s responsibility to foresee any resistance, act and over come these barriers. Habits are hard to break, people become familiar with particular practices; it is therefore vital that the change agent adopts a â€Å"bottom up† approach. All stakeholders will then have an active part in the change. Nurses’ who feel they lack the knowledge and are not happy about the change will be able to receive extra support from the ward manager, pain nurse or change agent. The implementation of the proposed change would mean that there would be a shortage of staff on the floor. Although the sessions are based on the ward they would still need to be carried out with minimal interruptions. This is a barrier to change. To overcome this barrier, the change agent can chose to have the sessions in the afternoon when both morning and afternoon staff are on the ward. As the session is only half an hour this would not cause too much disruption. Two sessions could be carried out so to see as many staff as possible. The achievement of this change will be shown by better results in patient care but also an improvement in ward team work which all leads to cost effective practice. This will be achieved, as patient recovery time will be reduced. Conclusion Change is indispensible in nursing practice for the improvement and transformation of health services, and is crucial in maintaining sound judgement together with effectiveness of best practice (Gopee and Galloway, 2009). Clinical effectiveness can be translated into clinical governance however for this to happen clinical practice must combine with the best available knowledge through research, clinical expertise and patient choice. This can be accomplished through training education and change management (Muir-Gray, 2001). This essay showed that the change needed for nurses was to introduce the NHS Enhanced Recovery programme (2008) into practice. For this to happen they would need to have short informal ward based training sessions to improve knowledge of pain and its management. The literature review showed that there was evidence there was a gap between nurse knowledge and how this affected the care patients were receiving. The change was implemented using lewin’s (1951) Force Field Analysis. The three stages showed driving and restraining forces but by the Re-freezing stage restraining forces had been limited so that there was equilibrium. Resistance and barriers to change were discussed including money, resources, time and how the change agent would overcome these. Once the Re-freezing stage had been implemented and therefore the change being successful it is important that the change is periodically evaluated to ensure that it does not slip back to the original state. References Allen, D. (2000) ‘The NHS is in need of strong leadership. ’ Nursing Standard. Volume: 14, (Issue: 25) p. 25 Aneurin Bevan Health Board (2010) Education and Development. Available at : http://www. wales. nhs. uk/sitesplus/866/page/40 (accessed October 16th 2011) Baulcomb, J. (2003). ‘Management of Change Through Force Field Analysis’. Journal of Nursing Management. Volume: 11, (Issue: 4), p. 275-280. 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Volume: 14, (Issue: 5), p 284-288. Thornhill A, Lewis P, Millmore M, Saunders M (2000) Managing Change. England Financial Times: Prentice Hall Wright J, and Hill P, (2003) Clinical Governance. London: Churchill Livingstone. Young J, Horton F, Davidhizare R (2006) Nursing attitudes and beliefs in pain assessment and management. Journal of Advanced Nursing 53 (4) 412-421. Appendix A Appendix B Activity|Timeline|Time Duration|Cost|Resources| Clinical-terms booklet|One month|Active/regularly|Ink+paper (50) leaflets+(50) questionnaires+time of printing= ? 100 |Expert practitioner, printing| Courses aimed at re-education for the improvement of pain management |Will know when the manager gives change agent time, date and room for all stakeholders to participate. |Twice a year|Varies on band of stakeholder. Approx ? 3500 for 50 participants +extra time of change agent to plan change. |Change agent to decide (will key stake holders assist in the process of change. | Constant communication|immediately|indefinite|? 100. 00|Information/notice boards| Source-Made by essay author How to cite Evidence Based Practice, Papers Evidence Based Practice Free Essays Evidence –based practice has been gaining acceptance and momentum in the social services professions. As evidence related to specific programs and inventions mount, social service practitioners and organizations around the world have increasingly begun to implement evidence-based programs as a strategy for creating better outcomes for children, families and adults. Unfortunately, the science of evaluating efficacious and effective programs and interventions has far out spaced the science of implementing them. We will write a custom essay sample on Evidence Based Practice or any similar topic only for you Order Now A gap exists between what we know works and being able to utilize what works in practice (Maynard, August 2009). The article allows you to question why it is so hard for people to understand concepts, theories and research that they have studied. The information that they know and have studied is being put in to practice. How can practitioners evaluate and come to conclusions on their studies of clients and don’t implement what they have studied? We all have clients that we use certain interventions for and we know what works for them but that doesn’t necessarily mean it will work for all of them. If 10 people are researched on a new technique that you have learned and they all respond positively to it, that doesn’t mean that the next 10 people you work with will respond the same way. While reviewing the article, consideration to the method the author is trying to implement came into question. Citations were by many appropriate sources. The citations show that she did research and was able to supplement her ideas with other sources besides herself. That doesn’t necessarily mean that she was able to find that source without doing the bottom-up search. The evidence points at a top-down search which would be logical. It is more feasible and less time consuming. She could read each and every source and find the information required then she would be fulfilling the bottom-up search. She was using many different resources to write the article. The author portrayed many good points in this article. She discussed how social service agencies can be learning organizations and they are (a) systems thinking, â€Å"allows us to look for and identify patterns and see the rganization as a dynamic system that impacts, and is impacted by, individuals and events inside and outside the organization† (Senge, 1990), (b) personal mastery, â€Å"people with high levels of personal mastery are more committed, take more initiative, have a broader and deeper sense of responsibility in their work and learn faster† (Senge, 1990) (c) mental models, â€Å"people expose their own thinking effectively and make that thinking open the influence of others† (Senge, 1990) (c) building shared vision, â€Å"building a shared vision takes time and grows as a result of interactions between individuals within the organization and the sharing of individuals’ visions† (Senge, 1990) and (d) team learning, â€Å"creating structures and processes that shift the organizations toward a commitment to learning provides a solid foundation for building a learning organization. The research was unbiased when defending the article. She informed the reader of the research that was performed by many other sources and allowed an opening for discussion whether it is valid or not. The research is not completed it is open ended for question and improvement. She expresses that â€Å"evidence based practice calls for different types of social service organizations that can learn on a continuous basis and adapt quickly and responsively to knowledge, research and the changes in the field that are occurring at a rapid pace† (Maynard, August 2009). She has great insight and theories to help agencies to improve and practice what they know. The article was based off of other sources and what they know and can teach us. More in depth personal research from the author and from the sources could provide a more in depth picture of how evidence-based practice can be dissected. How to cite Evidence Based Practice, Essay examples