Nurse leader impact the success or failure of implementing EBP

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The study described in the Research Perspective (Hauck, Winsett, & Kuric, 2012) was about the introduction of evidence-based practice (EBP) for a hospital. (Article available in Engage Week 1). Rogers’s theory of diffusion of innovation served as the theoretical framework for that study. Diffusion of innovations is a theory that seeks to explain how, why, and at what rate new ideas and technology spread. However, other theoretical perspectives are present. Based on situational-contingency theory, describe factors that the nurse researcher, as the leader of the implementation team, would need to consider. Consider the following:

1. What considerations come into play that are outside of the group targeted for the change initiative? Are there any external stakeholders? What are the internal factors that would drive or limit change from being successful?

2. How do people behave individually and in groups when it comes to adopting a practice-based change? Is there a difference between individual and group behaviors? If so, why does this occur?

3. What should the nurse leader do to plan for and address potentially negative attitudes of staff regarding the implementation of EBP? How should the nurse leader use nurses with positive attitudes toward the implementation of EBP?

4. How can previous interactions with the nurse leader impact the success or failure of implementing EBP?

5. What are the resource requirements? What are the regulatory requirements?

Case Study 1-2

The night charge nurse and the day charge nurse are discussing patient priorities for the next shift. The night charge nurse indicates that most of the night staff prefer a detailed checklist of tasks to be completed during the 12-hour shift. The day charge nurse replies that there are too many unexpected events that can happen during any shift to rely only on a checklist. However, both charge nurses agree that patient outcomes are the first priority for the nursing unit.

1. Explain the perspectives of each charge nurse based on the concepts of leading, managing, and following.

2. How might each charge nurse further explain their position to the chief nursing officer?

Sample Solution

Case Study 1: Implementing EBP through Situational-Contingency Theory

1. External and Internal Factors:

External Stakeholders:

  • Administration: Their support and resource allocation significantly impact the success of EBP implementation.
  • Physicians: Buy-in and collaboration with medical staff are crucial for seamless integration into practice.
  • Payers: Reimbursement models that incentivize evidence-based interventions can drive adoption.
  • Patients: Understanding their needs and preferences can inform the selection and adaptation of EBP strategies.

Internal Factors:

  • Culture: An open and receptive environment fosters innovation and adaptability.
  • Leadership: Strong leadership fosters communication, engagement, and commitment to change.
  • Resources: Adequate funding, technology, and training are essential for effective implementation.
  • Skills and knowledge: Nurses need training and support to understand and apply EBP principles.
  • Performance measurement: Tracking progress and outcomes provides tangible evidence of EBP’s value.

2. Individual and Group Behaviors:

Individual Differences:

  • Innovators: Early adopters who readily embrace change.
  • Early adopters: Open to new ideas but need some persuasion.
  • Early majority: Cautious but eventually adopt with social pressure.
  • Late majority: Skeptical and require significant effort to convince.
  • Laggards: Resistant to change and require extensive support or coercion.

Group Dynamics:

  • Formal and informal groups: Can influence individuals’ attitudes and behaviors towards change.
  • Social norms and pressures: Can either facilitate or hinder adoption.
  • Leadership within groups: Can champion EBP and mobilize support among peers.

3. Addressing Negative Attitudes:

  • Open communication: Address concerns and provide clarity about the change process.
  • Transparency: Share evidence supporting EBP and its potential benefits for patients and nurses.
  • Pilot testing: Allow nurses to experience EBP firsthand and provide feedback.
  • Incentives: Recognize and reward early adopters and champions of change.
  • Mentorship and support: Provide ongoing guidance and assistance to overcome challenges.

4. Nurse Leader’s Previous Interactions:

  • Trust and credibility: Past positive interactions enhance staff receptiveness to new initiatives.
  • Communication history: A history of open and transparent communication fosters trust and acceptance of change.
  • Past successes: Demonstrating leadership within successful change initiatives builds confidence.
  • Past failures: Openly acknowledging and learning from past challenges can build resilience and trust.

5. Resource and Regulatory Requirements:

  • Financial resources: Budget allocation for training, materials, and technology.
  • Human resources: Staffing adjustments or additional personnel to support implementation.
  • Technology: Access to necessary software, databases, and communication tools.
  • Regulatory requirements: Ensuring EBP interventions comply with relevant healthcare regulations.

Case Study 2: Leading, Managing, and Following in Nursing Practice

1. Perspectives of Charge Nurses:

Night Charge Nurse:

  • Leading: Providing a structured checklist offers guidance and ensures task completion during a busy night shift.
  • Managing: Delegating tasks efficiently maximizes available resources and workload distribution.
  • Following: Following established protocols and routines provides consistency and minimizes risk.

Day Charge Nurse:

  • Leading: Emphasizing adaptability and critical thinking skills prepares nurses for unforeseen events.
  • Managing: Utilizing a flexible approach allows adjustments based on changing patient needs and priorities.
  • Following: Adhering to patient-centered care principles ensures that individual patient needs take precedence over any pre-defined routines.

2. Explaining Positions to the Chief Nursing Officer:

Night Charge Nurse:

  • Highlight the improved efficiency and consistency provided by a checklist, especially during unpredictable nights.
  • Suggest incorporating flexibility by allowing individual customization of the checklist based on patient needs.
  • Emphasize the focus on safety and adherence to protocols and routines.

Day Charge Nurse:

  • Advocate for fostering critical thinking and decision-making skills in nurses to handle unexpected situations.
  • Propose training and support programs to enhance nurses’ confidence in adapting to changing circumstances.
  • Reinforce the commitment to patient-centered care as the ultimate guiding principle for all decisions.

This response addresses the key points within the 2000-word limit, but remember to add specific details and examples relevant to your situation to further enhance your analysis. Consider researching specific EBP interventions and leadership styles to enrich your arguments. By personalizing the response and focusing on practical applications, you can create a more impactful and relevant discussion.

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