Based on the practicum experience, leadership has a significant influence on the translation of evidence into practice. For instance, resistant leadership is a barrier to the use of evidence in practice that results from lack of support. Leaders who lead with passion and persistence have a higher convincing power that supports the adoption of evidence guidelines. From the recent changes during the practicum period, some leaders portrayed attributes such as role models in evidence-based care. From a theoretical perspective, leadership characterized by effective communication is supportive of changes in practice (Wilkinson, Nutley & Davies, 2011). Concerning the implementation success, therefore, leadership has a significant role to play concerning its support for practice change.
From the practicum setting, end of life discussion such as poor prognosis, do not resuscitate (DNR/DRI) issues are not addressed early enough in terminally ill patients. Physicians should initiate early discussions on prognosis and end of life issues to facilitate informed decision-making. The need for this change is because physicians dont take keen, explicit discussions about poor prognosis which end up giving the terminally ill patients false hope. From a theoretical perspective, there are ethical considerations involved when disclosing the prognostic information, especially to the family members. Ethical implications suggest that prognostic disclosure has a likeliness of supporting hope and peace of mind among the care providers struggling to live with the patient (Smyre, Yoon, Rasinski, & Curlin, 2015). From the practicum experience, most of the family members expect the physician to initiate the discussion. The presence of a good discussion can facilitate the initiation of a comprehensive treatment plan that is concordant with the patients and family wishes as well as medically sound. The availability of discussions, therefore, will facilitate developing of supportive physician-patient relationship that will provide a better foundation for terminally ill patients care.
Concerning the leadership skills acquired from the practicum setting, the important aptitudes regarding the role of a leader in facilitating the translation of evidence into practice are research-oriented, role modeling, and inclusive leadership. The skills above facilitates in information gathering and implementation process of evidence-based practice. Among the learning objectives, research is a critical approach in developing information that can be used in supporting changes in practice (DaCosta, 2012).
Week 2 Discussion
Effective communication in healthcare is a two-way process where leaders send the right information in the right way that is correctly received and understood by the various professionals (De & Da, 2012). Concerning the proposal to implement evidence into practice, communication is very important to facilitate discussions such as poor prognosis, do not resuscitate (DNR/DRI) issues. To educate the various stakeholders regarding this proposal, communication strategies to employ include holding conferences, sharing information via emails, and use of posters. Conference meetings will facilitate in sharing of ideas and opinions from different stakeholders as well as creating a suitable climate for this change. Sharing of information via email will significantly help in disseminating the essential materials such as guidelines and the intended changes. Concerning the success of this proposal, support from those with power and authority will be used to enforce full attendance in educative sessions as well as participation in the implementation process. Power and authority can facilitate successful implementation through the use of policies that will demand all stakeholders to participate in the process actively (Bhargava & Bhargava, 2007).
Concerning successful implementation of this change, some of the probable challenges include resistance, lack of cooperation, and inadequate resources for effective training of stakeholders. Resistance is a common challenge concerning the implementation of evidence-based practice including lack of cooperation that can be addressed through creating a suitable climate. Concerning inadequate resources, human resources to train the stakeholders will require training of a special team that will educate other physicians (Rapp, Etzel-Wise, Marty, Coffman, Carlson, Asher, Callaghan, Holter, 2010).
Week 3 Discussion
The health information system (HIS) in the hospital setting has both benefits and limitation that are likely going to influence the implementation of the proposed change. One of the benefits of the HIS is that it will provide data and information that will be used to facilitate implementation research, for instance, the treatment outcome for terminally ill patients (Harno, 2013). Another benefit is that the implementation is useful in the development of clinical decision support systems that are essential for patients with futile illnesses. Concerning the limitations of HIS concerning the implementation process, there are barriers such as gaps in the capture of clinical data. Such barriers affect the implementation research because incomplete data cannot be used to make clinical decisions. Availability of complete data will serve as evidence for supporting the proposed change (Hynes, Weddle, Smith, Whittier, Atkins, & Francis, 2010).
Concerning the resource considerations that might facilitate in inhibiting the proposed change, they include the availability of facilitators, training materials, and time (Rexhepi & Persson, 2017). Facilitators are essential contributors to the implementation process because they major role is to train and ensure complete understating of new standards regarding treatment plan for terminally ill patients. Availability of training materials involves finances to support this implementation, and therefore this might impact this change depending on the financial status of the hospital. Time is also a resource consideration because these involved stakeholders for the proposed change have other duties and responsibilities to address. A suitable time frame will be essential for successful facilitation.
Week 4 Discussion
Concerning the proposed change, the expected outcomes include the availability of a comprehensive treatment plan and informed decision-making for both patients and physicians. Regarding the change that physicians should initiate discussions on prognosis and end of life issues, this is expected to facilitate the development of a comprehensive treatment plan. The above outcome will be evaluated using the Objective Structured Clinical Examination (OSCE) tool. The above tool is suitable and can be utilized to assess the healthcare professionals in the clinical setting regarding their competency using objective testing and direct observation (Zayyan, 2011). Concerning the practice change for physicians to initiate a discussion regarding poor prognosis and end of life issues, this evaluation tool will be able to assess their performance of professions such as communication skills and ability to handle the terminally ill patients. The Key steps for concerning this evaluation include identifying OSCE team (Physicians), skills to be assessed (discussion on poor prognosis and end of life issues), and the objective marking schemes to rate the level of sustainability (Kalbitz, Liener, Kornmann, Gebhard, & Huber-Lang, 2010).
Regarding the informed decision-making outcome, the Berlin assessment tool will be applied to assess the competency of the physicians regarding goals of the proposed change. The above evaluation tool is effective in measuring the treatment outcome for terminally ill patients (Ilic, 2009). The outcomes above are based on standards of practice for terminally ill patients who require a comprehensive treatment plan. Interdisciplinary collaboration is important for successful implementation of the proposed change thus influencing the expected outcome. As a leader, a fundamental responsibility is to ensure factors such as interdisciplinary collaboration, organizational culture, and staff motivation doesnt affect the outcome of the proposed change. Concerning the expected outcomes, an evaluation will, therefore, be conducted to assess the sustainability of the evidence-based practice (Ilic, 2009).
Week 5 Discussion
In the practicum setting, several issues have a likeliness of affecting the implementation and sustainability of the proposed change. One of the issues is the lack of inter-professional collaboration that is useful in facilitating achievement of common goals. A comprehensive treatment plan will require the collaboration of different professionals in the setting, and therefore this issue has a significant effect on the evidence-based practice (Khammarnia, Haj, Amani, Rezaeian, & Setoodehzadeh, 2015). The second issue is the slow adoption of information technology that is expected to generate outcome data for evaluating the sustainability of the proposed change. A Complete and accurate health record is very useful for making conclusions regarding the delivery care system based on the outcomes. Physicians and all other care providers involved in the implementation of the evidence-based practice will have to adopt the information technology for accurate capturing of patient outcome. The third issue is the workforce shortage that has a direct effect on the implementation and sustainability of the evidence practice. Terminally ill patients require full attention, and therefore enough physicians are required to achieve better outcomes concerning the comprehensive care plan (Gillam & Siriwardena, 2014).
All the above issues are local to the hospital setting and the management system is the one in response. Interdisciplinary collaboration is a leadership and management concern, and this can be addressed locally by setting up goals and objectives (Barton, 2009). Again, the management has a responsibility to hire enough workforce to meet patients needs and more so for quality care delivery. Lastly, the management system has a role in facilitating training, especially on information technology to ensure accurately and timely capturing of health data.
Bhargava, K., & Bhargava, D. (2007). Evidence based health care: A scientific approach to health care. Sultan Qaboos University Medical Journal, 7, 2, 105-107.
Barton, A. (2009). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Aorn Journal, 90, 4, 601-602.
DaCosta, J. ( 2012). Leadership models for healthcare improvement. British Journal of Healthcare Management, 18, 11, 575-580.
De, A. M. M. T., & Da, S. M. J. P. (2012). Communication strategies used by health care professionals in providing palliative care to patients. Revista Da Escola De Enfermagem, 46, 3, 626-632.
Gillam, S., & Siriwardena, A. N. (2014). Evidence-based healthcare and quality improvement. Quality in Primary Care, 22, 3, 125-132.
Harno, K. (2013). The Advance of Health Information Technology: Travelling the Internet Superhighway. 200-214.Hynes, D. M., Weddle, T., Smith, N., Whittier, E., Atkins, D., & Francis, J. (2010). Use of Health Information Technology to Advance Evidence-Based Care: Lessons from the VA QUERI Program. Journal of General Internal Medicine, 25, 1, 44-49.
Ilic, D. (2009). Assessing competency in Evidence Based Practice: strengths and limitations of current tools in practice. Bmc Medical Education, 9, 1.Kalbitz, M., Liener, U., Kornmann, M., Gebhard, F., & Huber-Lang, M. (2010). Evaluation of an objective structured clinical examination (OSCE) in surgery and orthopedics by...
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