Overview
To Prepare:
- Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
- Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
- Consider the best method of disseminating the results of your presentation to an audience.
The Assignment: (Evidence-Based Project)
Part 4: Recommending an Evidence-Based Practice Change
Create an 8- to 9-slide narrated PowerPoint presentation in which you do the following:
- Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
- Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
- Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
- Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
- Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
- Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
- Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
- Add a lessons learned section that includes the following:
- A summary of the critical appraisal of the peer-reviewed articles you previously submitted
- An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)
- Here is my picot model
- My clinical issue of interest is the use of telehealth to improve healthcare access for patients in rural communities. Rural populations often face barriers to care, including provider shortages, geographic isolation, and transportation challenges. Telehealth has emerged as a promising intervention that enables remote access to healthcare services, potentially improving health outcomes and reducing disparities in care.Using the Walden Library, I searched the CINAHL and PubMed databases to identify original research studies on telehealth and rural healthcare access. I began with the keyword "telehealth," which returned thousands of results. To narrow the search, I added terms such as "rural communities," "healthcare access," and "chronic disease management" using the Boolean operator AND. For example, the search "telehealth AND rural healthcare" produced approximately 450 articles, while "telehealth AND rural healthcare AND chronic disease management" reduced the results to approximately 120 articles. Applying filters for peer-reviewed journals, full-text availability, and publication dates within the last five years further narrowed the search to four highly relevant original research articles.My PICOT question is: Among adults living in rural communities (P), how does telehealth-based healthcare delivery (I), compared with traditional in-person care (C), affect access to healthcare services and chronic disease management outcomes (O) over 12 months (T)?To increase the rigor and effectiveness of my database search, I would use multiple databases, controlled vocabulary such as Medical Subject Headings (MeSH), and Boolean operators (AND, OR, NOT). For example, searching "telehealth OR telemedicine" broadens the results, while combining those terms with "AND rural health" increases relevance. Additionally,limiting searches to peer-reviewed original research and using citation tracking can help identify high-quality evidence for the PICOT question.ReferencesButzner, M., & Cuffee, Y. (2021). Telehealth interventions and outcomes across rural communities in the United States: Narrative review. Journal of Medical Internet Research, 23(8), e29575.Haleem, A., Javaid, M., Singh, R. P., & Suman, R. (2021). Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sensors International, 2, 100117.Sutarsa, I. N., Kasim, R., Steward, B., Bain-Donohue, S., Slimings, C., Hall Dykgraaf, S., & Barnard, A. (2022). Implications of telehealth services for healthcare delivery and access in rural and remote communities: Perceptions of patients and general practitioners. Australian Journal of Primary Health, 28(6), 522–528.
- Disssemination Strategies for Evidence-Based PracticeThe dissemination of evidence-based practice (EBP) is a critical factor in translating the EBP findings into real life change. Dissemination is not separate from the EBP process but is the pathway to getting knowledge from individual clinicians or project teams to the practice community (Melnyk & Fineout-Overholt, 2023). To ensure maximum impact, the correct approach and its possible constraints must be considered.Strategies I Would Be Most Inclined to UsePresentations at the Unit level / Organization level. I would make sure to bring my findings right to the unit or department where my practice change would take place. This approach engages in the ongoing dialogue with the staff who will put the change into practice and fosters buy-in as colleagues are able to ask questions and express concerns as they evolve as the change is being implemented (Melnyk & Fineout-Overholt, 2023). The Unit-level presentation is another good method of reaching frontline workers who might not go to a national conference or read a peer-reviewed journal, making it one of the more practical approaches to impact daily care.Publication in a peer-reviewed journal. I would also aim to publish my project in a journal, as this will help to promote the project well beyond one institution. Peer review generates credibility, rigor, and creates permanent record (searchable) to build on, once published, for other clinicians and researchers (Melnyk & Fineout-Overholt, 2023). In this way it is necessary to contribute to the profession beyond the scope of the local project where the institution started out.Strategy I Would Be Least Inclined to UseI would be least likely to use poster as a single technique. Although posters can have a lot of valuefor creating immediate awareness at conferences, they generally offer limited scope for active response – participants just pass by them, read the information, and then either move on or have an in-depth conversation about it (Melnyk & Fineout-Overholt, 2023). A poster has less margin for nuance than a podium presentation or journal article and is less open to detailed questions or retention or application of the information than is a journal article presented orally. Even then, I would still call it a valuable additional tool - though not a main dissemination tool.Barriers to the Preferred StrategiesBarrier 1: Time and concurrent clinical needs. One of the difficulties in unit level presentations is the lack of time for all staff members to discuss them on all shifts. Shifts, holidays, and weekends are busy hours both for the staff and for students, with single, one-off presentations making it difficult if the teaching must take place during busy periods.Barrier 2: Manuscript rejection and peer review process—the peers are the problem. The length and competitiveness of the review process for a journal publication are a great challenge. Many manuscripts are originally rejected even with the first submission and, if accepted, the time from submission to publication may be several months to more than a year and prevent timely dissemination of important data.Barrier 3: Writing skills and lack of knowledge about the publication process. Having a fine hand may not align with being effective at academic writing conventions, the process of formatting, or entering information into a journal submission portal and can make the prospect of authorship unappealing even for excellent hands.Overcoming the BarriersI would repeat a unit level presentation multiple times during the day, night and on weekends to accommodate scheduling difficulties, and I would also record a brief audio version, in case any staff could not make it to the one that obviously would be attended in person. A one-page summary or an infographic would also help to re-enforce the message for those that missed the live session and would be left at the nurses' station.If wanting to address the challenges of publication, I would look for a mentor or co-author who has published previously, such as a nurse researcher, clinical nurse specialist or faculty member, to prepare the manuscript ensuring the best chance of being accepted. Also, I would do careful due diligence in the preliminary research into author guidelines before submission and perhaps submit to several different and suitable journals if rejected on entry, instead of giving up upon rejection—when it typically is not a final answer, but a stopping point to learn more (Melnyk & Fineout-Overholt, 2023). Lastly, and perhaps most importantly, attending a scholarly writing workshop or availing institutional support resources in the writing process may assist nurturing one's skills and confidence in completing the process.ReferenceMelnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.