Abby C Kurtz, EdD, RN-BC Director, Education & Research Bronx Lebanon Hospital Center Bronx, NY 10457

Transcription

1 Abby C Kurtz, EdD, RN-BC Director, Education & Research Bronx Lebanon Hospital Center Bronx, NY 10457

2 1. Describe the four critical elements of an organization. 2. Describe leadership strategies that strengthen these four critical elements in the achievement of organizational goals. 3. Describe a process of transforming an organizational culture towards EBP. 2

3 The Barriers Scale & Evidence-based practice questionnaire (EBPQ) Organization: infrastructures and resources Research dissemination: access and process Quality of research: Skill deficit in critical appraisal Nurse: lack of time, lack of expertise, and authority 3

4 1. Evidence-informed clinical decision-making. 2. Evidence-based policies and procedures. 3. Evidence-informed administrative decisions and actions. 4. Evidence-based education curriculum design, content, and delivery. 4

5 Open and receptive to new ideas Innovation and transformation takes place at the bedside Research evidence is readily available Nurses expertise is valued Patients preferences are respected 5

6 1. Nurses have a professional responsibility to base their care on the best available evidence. 2. Nurses who work at the bedside know their patients - needs, values, preferences and are able to examine the evidence based on current research findings and experiential coherence and insight. 3. The organization provides leadership and structural support for EBP implementation. 6 6

7 CS STRUCTURAL EMPOWERMENT SIDE ack/2011 7

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9 Foundation EBP Implementation Kurtz, A. (2010) 9

10 The EBP Paradigm Translation to Practice Contextual appropriate ness Kurtz, A. (2010) 10

11 The Scientific Method Process Evaluation Current Conditions Root Cause Countermeasures TEST Kurtz, A. (2010) 11

12 1. Compelling vision for EBP 2. Develop people as the most important primary resource 3. Create the path for EBP 4. Embed EBP in the strategy, structure and process 12

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14 An organizational Core Value Mission, Vision Embedded in the System Structure Processes Palpable within the organizational Culture Staff development 14

15 Effective organizational structures are innovative, creative, have the capacity for problem-solving, and employee-empowering Resources required to learn, teach and practice EBP: Time, Space, Technology, Personnel Shared Governance (as a leadership structure) Best practice Guidelines Policies and Procedures 15

16 Key strategic objective Imperative leadership investment Develops nurses as knowledge workers Continuous learning environment A learning climate 16

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18 Characteristics (Schalk et al, 2010) 1. Safety: Physical, psychological 2. Professional development a. Teamwork : Collaboration b. Autonomy: Respect for the nurse s contribution c. Leadership support d. Participation in decision making 18

19 Improving communication Promoting knowledge transfer Supporting team work and collaboration Providing decision support at real time 19

20 Developing expertise Support to expertise Access to new information Access to resources 20

21 Jack Mezirow( ) 3 decades of theory development Emphasizes contextual understanding, critical reflection on assumptions, and validating meaning by assessing reasons. Transformative learning is a subset of adult learning; NOT ALL adult learning is transformative. 21

22 Definition: Reflecting on the limits of knowledge, the certainty of knowledge, and criteria for knowing. We learn from subjective interpretation of experiences and focuses on HOW we know. Learning does not come from experience, but rather from reflecting on experience 22

23 Aim (Individual level): To develop the critical thinking skills of the knowledge-worker. Goal for Nurses: To examine our actions and the views that lead to our actions by exploring the values and knowledge on which they are based. 23

24 Aim (Organizational level): To create empowering strategies, structures, and processes to achieve sustainable organization change toward EBP. Goal: To develop transformational leaders at all levels within the organization 24

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26 A commitment to test knowledge through reflection of experience and the willingness to learn from colleagues and from patients. Critical reflection is necessary for transformative learning. 26

27 Testing knowledge by observing what happens and critically appraising the evidence. 27

28 Role-modeling of the behaviors and skills that support the desired culture for an EBP environment: - Reflective practice - Using the scientific method - The EBP paradigm - Organizational model 28

29 Developing mastery for experiential coherence and insight (making sense of what is). Appraising the effectiveness of EBP pedagogy 29

30 The Scientific Method Process Evaluation Current Conditions Root Cause Countermeasures TEST Kurtz, A. (2010) 30

31 EBP TL TL THE RIGHT THING TO DO Why EBP? ack/

32 I. Engage: One unit at a time. II. Organizational Assessment: On-going III. Alignment and Engagement at ALL levels IV. Organizational Priorities A. Competency Assessment Program B. Pressure Ulcer management C. Knowledge-Based Charting 32

33 Strategy Structure People Process PCC SD SE PI Resources Policy Knowledge Mgt Governance Mentors Knowledgeworkers Critical thinkers Commitment Transformative learning Transformation o Recognition o Vision o Learning o Action o Integration 33

34 Structure: Resources: Master s prepared Facilitators HealthStream LMS; CPMRC Staff-led Committees: EBP Projects Shared Governance Structure: Policy Decisions EMR: CPOE, CDSS; CPG 34

35 Process: EBP Implementation 1. Organizational Assessment 2. EBP Training: All-levels 3. Infrastructure for innovation 4. BPG translation to practice 5. Ongoing evaluation 35

36 Increased number of Master s-prepared RNs EBP Scholars Program training 1-2 Research projects per year 1-2 EBP projects per year Adequate resources for information technology Focus: Sustainability of Progress 36

37 Practice Patient Education Quality Patient Care Flow Leadership Operational Failures Training Preceptorship Organizational model towards EBP/ack/

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