Download - Laura Cullen, DNP, RN, FAAN 15 6/3/2019
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Evidence-Based Healthcare – Creating and Sustaining it with the Interprofessional Team
15th Annual Methodist Research Day
Laura Cullen, DNP, RN, FAANEBP ScientistOffice of Nursing Research & EBPDepartment of Nursing Services and Patient CareUniversity of Iowa Hospitals and Clinics
Greetings from Iowa and University of Iowa Hospitals and Clinics
https://uihc.org/nursing-iowa
Disclosure
Financial disclosure: 3M
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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ObjectivesTeams are intended to “get everyone on the same page”
Discuss strategies for positive team functioning to promote evidence-based practice (EBP)
Describe team roles that support provision of evidence-based healthcare
Current state of healthcareThe pace of practice and change will continue
Pain Medication Administration Upon Admission after TKR
Cullen, Pennathur, Onsongo, Tripp Reimer, Farrington, Rakel, Herr, Strabala, Schomberg
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Organizational Leader’s RoleLeaders have responsibility to create the foundation
Big C’s FrameworkCommunication is foundational to quality healthcare
Communication
Coordination
Collaboration
Climate
Competence
Coordination
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Teams - OrganizationalBroadly reflect the stakeholders across clinical areas and roles. Be inclusive.
EVIDENCE-BASED PRACTICE IN ACTION
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EBP Project Director
Lead/Facilitate project Oversee process Collaborate with team Clinical expert Utilize experts Problem solve Establish meeting schedule Set agenda and run
meetings Determine timeline with
group Delegate work assignments
Keep team moving forward
Work closely with project practice mentor
Keep advisor and stakeholders well informed
Team meetingsEstablish working process decisions and ground rules early
Clear purpose and objectives
Identified process (establish the method to be followed)
Provide agendas
Chose a standing meeting time- cancel as needed
Use the action plan
Keep moving forward despite challenges
Seize opportunities
Look for easy solutions first
Report progress
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Team Rules
Active participation is expected
Everyone’s time is respected
Questioning is valued
Decisions are made by team consensus
Meetings generate action steps
Keep an open mind and let evidence lead to a solution
EVIDENCE-BASED PRACTICE IN ACTION
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EBP Project TimelineSteady progress toward the goal
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Benefits of Using Action Plans
Outlines steps in the EBP process
Identifies responsibility/accountability
Divides work
Sets goals by providing a timeline
Communicates work accomplished
Assists with review of next steps
Keeps projects moving forward
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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EBP Action PlanFacilitates team work
Key Step or Objective
Specific Activity to Meet the Objective
Person Responsible
Resources Needed
Timeline Evaluation
EVIDENCE-BASED PRACTICE IN ACTION
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Project Director (name): Team:
Purpose
Reminders about Action PlanProvides solid ground for stable and strategic planning
Fluid and dynamic; not too rigid
Adjusted over time to meet project purpose and goals
Application-oriented
Identify next key steps or objectives
Breakdown into action steps
Delegate and collaborate
Collaboration
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Patient at the Center
LeadershipLeadership is a key to success and the role has not been well described
“Look for helpers. You will always find people who are helpers.”
-Mr. Rogers
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Teams – Unit/clinic SpecificCore groups expand the influence to reach each clinician team member
Cullen, L., Hanrahan, K., Farrington, M., DeBerg, J. Tucker, S., & Kleiber, C. (2018). Evidence-based practice in action: Comprehensive strategies, tools and tips from the University of Iowa Hospitals and Clinics. Indianapolis, IN: Sigma Theta Tau International.
EVIDENCE-BASED PRACTICE IN ACTION
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Change Agent Roles
Change Champion
Core Group
EBP Facilitator
Opinion Leader
Knowledge Broker
EVIDENCE-BASED PRACTICE IN ACTION
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EBP Facilitator/Mentor
Guide others through EBP process
Provide access to resources
Assist with most difficult steps Evidence Finding, appraising, and synthesis
Local data
Design and format the practice change
Developing implementation plan
Developing an evaluation plan
Anticipate and troubleshoot challenges
Keep project on track
Assure approvals are in orderEVIDENCE-BASED
PRACTICE IN ACTION
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Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Identifying an Opinion LeaderCredible, trusted, informal leader whose ideas and behaviors are a model for peers
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Opinion Leader
EVIDENCE-BASED PRACTICE IN ACTION
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Identifying EBP Change ChampionsCharacteristics of emerging leaders to consider for future opportunities
EVIDENCE-BASED PRACTICE IN ACTION
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Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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EBP Change ChampionExpand the sphere of influence
Abdullah, Rossy, Ploeg, Davies, Higuchi, Sikora, & Stacey, 2014; Fleuren, Van Dommelen, & Dunnink, 2015; Greenhalgh, 2018; Hauck, Winsett, & Kuric, 2013; Kaasalainen, Ploeg, Donald, Coker, Brazil, Martin-Misener, Dicenso, Hadjistavropoulos, 2015; Ploeg, Skelly, Rowan, Edwards, Davies, Grinspun, Bajnok, & Downey, 2010; Titler, 2008; Rogers, 2003
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Unit/clinic Leaders Role
Unit/Clinic Leader Role in EBPKey role in success
Set expectations on unit
Facilitate work time
Discuss project with nursing staff & other disciplines
Cheerleading project importance
Track progress
Maneuvering in the system (key players, committees, etc.)
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Every Clinician is a Leaders
Climate
You want me to do what?Design the EBP intervention so it will work for the majority of patients and within the work flow
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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TroubleshootEvery patient is unique and has unique characteristics to address
Design the practice change to meet the majority of most typical patients
Avoid delays from attempting to meet every patients needs
Retain core elements – required for desired outcome
Requires access to experts
Apply the best evidence
Clinician InputBring the perspective of stakeholders to the planning table
Listen to clinician questions
Select influential core group members
Use Precision Implementation Approach
Keep moving forward
Clinician TrainingClinicians have a role in keeping practice current and provision of EBP
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Be AdaptiveAnticipate that midstream corrections will be needed from lessons learned
vs.
PersistPersistence and keeping the end in mind will help you pervail
Begin by asking “how can we make this work”?
Build each initiative using a stepwise approach, linked to the goals
Never quit – do the right thing
“If not now, when? If not you, who”?
Track and Celebrate SuccessCelebration sets the bar so all will better understand expectations
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Competence
Evidence-Based Practice
Evidence-based practice is the process of shared decision-making between practitioner, patient and others significant to them based on research evidence, the patient’s experiences and preferences, clinical expertise or know-how, and other available robust sources of information (STTI, 2008)
Integration of best research evidence with clinical expertise and patient values (Sackett et al, 2000)
Process/methodsIdentify the process or methods to be used early in team development
Iowa Model Collaborative, 2017, Worldviews on Evidence-Based Nursing
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Diffusion Model: Innovation-Decision Process
I.Knowledge
II.Persuasion
III.Decision
IV.Implementation
V.Confirmation
AwarenessAwareness, Attitude
& Behavior Change
Awareness &
Attitude Change
Passive Active Interactive
(Grol, Wensing & Eccles, 2005; Logan & Graham, 1998; Rogers, 2003; Veniegas, Kao, Rosales, & Arellanes, 2009)
I.Creating
Awareness & Interest
II.Building
Knowledge & Commitment
III.Promoting Action & Adoption
IV.Pursuing
Integration & Sustained Use
ImplementationMany decisions involved in implementation planning
Cullen, L. & Adams, S. (2012). Planning for Implementation of Evidence-Based Practice. Journal of Nursing Administration, 42(4), 222-230.
Leadership lessons TED talk
Phased Approach
EBP Implementation GuideImplementation planning is not linear and there are many options from which to choose
(Cullen & Adams, 2012)
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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(Cullen & Adams, 2012)
Implementation Target
*Strategies with the strongest evidence base
Update Team for Sustaining the ChangeIntegrating the practice change requires build it into the system
Unit QI Coordinator Include in annual unit QI goals
Divisional QI Coordinator Report results on QM report form
Nurse Educator Orientation checklist
Competency assurance
Nursing Informatics
EBP Examples
Interprofessional Teams Improving Quality Healthcare
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Sample EBP initiatives and teamsTeam membership reflects the stakeholders
Oral mucositis during treatment for head and neck cancers Nurse-led
College of Dentistry; radiation technicians; MA; physicians; front desk personnel; hospital dentistry; OT; Oral pathologists; volunteers
Patient/family input
OR smoke plume evacuation Nurse-led
Surgeons; anesthesia; surgical technicians; supply chain
ICU early mobility Nurse-led
PT/OT; RT; physicians; LIP; NA; ergonomics specialist
Impact: WorkloadTeamwork – when done well, optimizes everyone’s strengths and reduces critical clinician workload
Big C’s FrameworkStrength of an organization is the people
Communication
CoordinationTeam work
Action planning
Collaboration
Patient
Leadership
Change Agent Roles
Climate
Troubleshooting
Clinician involvement
Adaptive
CompetenceEBP methods
Implementation science
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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What I Need from You
Use 1-2-4-All• Silent self-reflection
- What are my needs- What are my challenges- What are my opportunities
• Share with your partner(s)- Discuss - Generate actionable requests
• Share with a foursome- What ideas stood out as most important
• Report two most important requests for your success in your clinical area(s)
http://www.liberatingstructures.com/7-15-solutions/
ConclusionWait! There is an “I” in team!
“There is no “I” in team, but there is in win.”-Michael Jordan
Questions &
Ideas
Thank you for promoting evidence-based healthcare
Laura Cullen, DNP, RN, FAAN 15th Annual Methodist Research Day6/3/2019
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Select References - Team
• AHRQ (2014). TeamSTEPPS 2.0 Essentials Course. Content last reviewed March 2019. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamstepps/instructor/index.html
• Almost, J., Wolff, A. C., Stewart‐Pyne, A., McCormick, L. G., Strachan, D., & D'Souza, C. (2016). Managing and mitigating conflict in healthcare teams: an integrative review. Journal of Advanced Nursing (John Wiley & Sons, Inc.), 72(7), 1490-1505.
• Baik, D., & Zierler, B. (2019). Clinical nurses' experiences and perceptions after the implementation of an interprofessional team intervention: A qualitative study. Journal of Clinical Nursing (John Wiley & Sons, Inc.), 28(3/4), 430-443.
• Cullen, L., Hanrahan, K., Farrington, M., DeBerg, J., Tucker, S., & Kleiber, C. (2018). Evidence-Based Practice in Action: Comprehensive Strategies, Tools and Tips from the University of Iowa Hospitals and Clinics. Indianapolis, IN: Sigma Theta Tau International.
• Körner, M., Bütof, S., Müller, C., Zimmermann, L., Becker, S., & Bengel, J. (2016). Interprofessional teamwork and team interventions in chronic care: A systematic review. Journal of Interprofessional Care, 30(1), 15-28.
• Iowa Model Collaborative (2017). Iowa Model of Evidence-Based Practice: Revisions and Validation. Worldviews on Evidence Based Nursing, 14(3), 175-182. doi: 10.1111/wvn.12223.
• Miller, C., Kim, B., Silverman, A., Bauer, M. (2018). A systematic review of team-building interventions in non-acute healthcare settings. BMC Health Services Research, 18:146. https://doi.org/10.1186/s12913-018-2961-9
• Patterson, M. E., Bogart, M. S., & Starr, K. R. (2015). Associations between perceived crisis mode work climate and poor information exchange within hospitals. Journal of Hospital Medicine, 10(3), 152-159.
• Petit Dit Dariel, O., & Cristofalo, P. (2018). A meta-ethnographic review of interprofessional teamwork in hospitals: what it is and why it doesn't happen more often. Journal of Health Services Research and Policy, 23(4), 272-279.
• Salas, E., Wilson, K. A., Murphy, C. E., King, H., & Salisbury, M. (2008). Communicating, coordinating, and cooperating when lives depend on it: tips for teamwork. Joint Commission Journal on Quality & Patient Safety, 34(6), 333-341.
• Sargeant, J., Loney, E., & Murphy, G. (2008). Effective interprofessional teams: 'contact is not enough' to build a team. Journal of Continuing Education in the Health Professions, 28(4), 228-234.
Select References –Change Champions• Abdullah, G., Rossy, D., Ploeg, J., Davies, B., Higuchi, K., Sikora, L., & Stacey, D. (2014). Measuring the
effectiveness of mentoring as a knowledge translation intervention for implementing empirical evidence: A systematic review. Worldviews on Evidence-Based Nursing, 11(5), 284-300. doi: 10.1111/wvn.12060
• Fleuren, M. A., van Dommelen, P., & Dunnink, T. (2015). A systematic approach to implementing and evaluating clinical guidelines: The results of fifteen years of preventive child health care guidelines in the Netherlands. Social Science & Medicine, 136-137,35-43. doi:10.1016/j.socscimed.2015.05.001
• Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581-629. doi: 10.1111/j.0887-378X.2004.00325.x
• Hauck, S., Winsett, R. P., & Kuric, J. (2013). Leadership facilitation strategies to establish evidence-based practice in an acute care hospital. Journal of Advanced Nursing, 69(3), 664-674. doi: 10.1111/j.1365-2648.2012.06053.x
• Kaasalainen, S., Ploeg, J., Donald, F., Coker, E., Brazil, K., Martin-Misener, R., . . . Hadjistavropoulos, T. (2015). Positioning clinical nurse specialists and nurse practitioners as change champions to implement a pain protocol in long-term care. Pain Management Nursing, 16(2), 78-88. doi: 10.1016/j.pmn.2014.04.002
• Ploeg, J., Skelly, J., Rowan, M., Edwards, N., Davies, B., Grinspun, D., . . . Downey, A. (2010). The role of nursing best practice champions in diffusing practice guidelines: A mixed methods study. Worldviews on Evidence-Based Nursing, 7(4), 238-251. doi: 10.1111/j.1741-6787.2010.00202.x
• Titler, M.G. (2008). The evidence for evidence-based practice implementation. In R. Hughes (Ed.), Patient safety & quality - An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Available from: http://www.ahrq.gov/qual/nurseshdbk/
• Rogers, E. (2003). Diffusion of Innovation (5th ed.). New York: Free Press.
Select References – Opinion Leaders
• Anderson, C., & Titler, M. (2014). Development and verification of an agent-based model of opinion leadership. Implementation Science, 27;9:136. doi: 10.1186/s13012-014-0136-6.
• Breimaier, H., Halfens, R., Wilborn, D., Meesterberends, E., Haase Nielsen, G., Lohrmann, C. (2013). Implementation Interventions Used in Nursing Homes and Hospitals: A Descriptive, Comparative Study between Austria, Germany, and the Netherlands. International Scholarly Research Notices, 14,http://dx.doi.org/10.1155/2013/706054
• Carpenter, C.R., Sherbino, J. (2010). How does an "opinion leader" influence my practice? CJEM, 12(5), 431-4. • Farley, K., Hanbury, A., Thompson, C. (2014). Gathering opinion leader data for a tailored implementation
intervention in secondary healthcare: a randomised trial. BMC Medical Research Methodology. 10;14:38. doi: 10.1186/1471-2288-14-38.
• Flodgren, G, Parmelli, E., Doumit, G., Gattellari, M., O'Brien, M.A., Grimshaw, J., Eccles, M.P. (2011). Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Systematic Reviews, 10;(8):CD000125. doi: 10.1002/14651858.CD000125.pub4.
• Lugtenberg, M., Burgers, J., Han, D., Westert, G. (2014). General preferences for interventions to improve guideline adherence. Journal of Evaluation in Clinical Practice, 20(6). 820-6. doi: 10.1111/jep.12209.
• Miech, E. (2016). Inside Help: A Systematic Review of Champions in Healthcare-Related Implementation. QUERI Implementation Network. Retrieved July 27, 2016, from: http://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=1160
• Rogers, E. (2003). Diffusion of Innovation (5th edition). New York: Free Press. • Rosen, B.L., Goodson, P., Thompson, B., Wilson ,K.L. (2015). School nurses' knowledge, attitudes, perceptions of
role as opinion leader, and professional practice regarding human papillomavirus vaccine for youth. Journal of School Health. 85(2):73-81. doi: 10.1111/josh.12229.