Development of a Multidisciplinary Evidence-Based Framework for Sustaining Change in Pediatric Nursing Practice

2.50
Hdl Handle:
http://hdl.handle.net/10755/203234
Type:
Presentation
Title:
Development of a Multidisciplinary Evidence-Based Framework for Sustaining Change in Pediatric Nursing Practice
Abstract:
(Summer Institute) Problem: Despite many strong EBP models for initiating change in pediatric nursing practice, the challenge to sustain change over time remains. The purpose of this EBP project was to identify the most effective strategies to sustain change from a variety of different disciplines, develop them into a framework to change practice, and test the framework in two pediatric units using the problem of needle stick pain prevention. Evidence: Iowa model of EBP (Titler, 2001) guided this project. Extensive search of multidisciplinary on-line databases provided summary evidence from: 1) psychology: successful change related to congruent decisions, 2) neuroscience: changes in brain neuroplasticity related to repetition, 3) cognitive behavioral therapy: successful change and axiomatic rules, 4) business: guidelines for making change stick, 5) nursing: change related to cultural assessment. Strategy: This evidence was incorporated into an implementation framework with strategies for sustaining change in pediatric nursing practice. Practice Change: To pilot and evaluate the change framework, a multidisciplinary group of pediatric nurses and caregivers from the E.D. and post-surgical in-patient units were recruited for an EBP team to improve needle stick pain prevention (NSPP). Key stakeholders from various parts of the hospital participated, including a pharmacist and laboratory technician. Evaluation: Baseline data was collected by surveying healthcare providers regarding their perceived importance for the use of pain prevention measures prior to performing needle stick. Additional data collected included current pharmacological and non-pharmacological practice. The culmination of this data suggested that previous strategies to implement EBP for NSPP were inadequate. Results: Two year follow up shows increased use of pharmacological and non-pharmacological practices and increased patient/parent satisfaction with NSPP. Recommendations: Multidisciplinary evidence based strategies to help sustain change in practice can enhance adoption and help overcome barriers. Lessons Learned: Meaningful change takes time in a large organization. Early adopters and champions can help pave the way for areas slower to adopt new change. Identifying key stakeholders and best communication strategies enhances positive outcomes. Bibliography: Ales, R., May, D., & Whitney, L. (2007). A study comparing chloroprocaine with lidocaine for skin infiltration before intravenous catheter insertion. American Association of Nurse Anesthetists, 75(4), 255-258. Baxter, A., Ewing, P., Evans, N., Ware, A., Mix, A., & Manworren, R. EMLA application in triage improves venipuncture success, poster presentation, Children’s Medical Center, Dallas. Christensen, C. M., Marx, M., & Stevenson, H. H. (October 2006). The tools of cooperation and change. Harvard Business Review, http://hbr.harvardbusiness.org/2006/10/the-tools-of-cooperation-and-change/ar/1, date accessed 8/31/09. Cohen, L. (November 2008). Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics, 122(Supplement 3), S135-S139. Davies, R. J. (2003). Buffering the pain of local anaesthetics: A systematic review. Emergency Medicine, 15, 81-88. Du, S., Jaaniste, T., Champion, G. D., & Yap, C. S. L. (August 2008). Theories of fear acquisition: The development of needle phobia in children. Pediatric Pain Letter, 10(2). Ford, J. D., & Ford, L. W. (April 2009). Decoding resistance to change. Harvard Business Review. http://hbr.harvardbusiness.org/2009/04/decoding-resistance-to-change/ar/1, date accessed 8/31/09. Garvin, D. A., & Roberto, M. A. (February 2005). Change through persuasion. Harvard Business Review. http://hbr.harvardbusiness.org/2005/02/change-through-persuasion/ar/1, date accessed 8/31/09. Granger, B. Practical steps for evidence based practice. Advanced Critical Care Nursing, 19(3), 314-324. Grabe, M., Yegiyan, N., & Kamhawi, R. (2008). Experimental evidence of the Knowledge gap: Message arousal, motivation, and time delay. Human Communication Research, 34, 550-571. Grol, R. (May 2008). Knowledge transfer in mental health care: How do we bring evidence into day to day practice? Canadian Journal of Psychiatry, 53(5), 275-276. Hagel III, J., Brown, J. S., & Davison, L. The big shift: Measuring the forces of change. Harvard Business Review, http://hbr.harvardbusiness.org/2009/07/the-big-shift/ar/1, date accessed 8/31/09. Hammer, M. (April 2004). Deep change: How operational innovation can transform your company. Harvard Business Review, http://hbr.harvardbusiness.org/2004/04/deep-change/ar/1, date accessed 8/31/09. Kegan, R., & Lahey, L. L. (November 2001). The real reason people Won’t change. http://hbr.harvardbusiness.org/2001/11/the-real-reason-people-wont-change/ar/1, date accessed 8/31/09. Kennedy, R., Luhmann, J., & Zempsky, W. (November 2008). Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics, 122(Supplement 3), S130-S133. Ketelaar, M., Russell, D., & Gorter, J. W. (2008). The challenge of moving evidence-based measures into clinical practice: Lessons in knowledge translation. Physical and Occupational Therapy in Pediatrics, 28(2), 191-206. Kotter, J. P. Leading change: Why transformation efforts fail. Harvard Business Review. http://hbr.harvardbusiness.org/2007/01/leading-change/ar/1, date accessed 8/31/09. Kotter, J. P., & Schlesinger, L. A. (July-August 2008). Choosing strategies for change. Harvard Business Review, http://hbr.harvardbusiness.org/2008/07/choosing-strategies-for-change/ar/1, date accessed 8/31/09. Lander, J., Weltman, B., & So, S. (2006). AMLA and amethocaine for reduction of children's pain associated with needle insertion. Cochrane Database of Systematic Reviews 2006, Art. No. CD004236(3). Leahy, S., Kennedy, R., Hesselgrave, J., Gurwitch, K., Barkey, M., & Millar, T. (November 2008). On the front lines: Lessons learned in implementing multidisciplinary peripheral venous access pain-management programs in pediatric hospitals.122(Supplement 3), S161-S170. Litva, A., & Peters, S. (2008). Exploring barriers to teaching behavioral and social sciences in medical education. Medical Education, 42, 309-314. Luhmann, J., Hurt, S., Shootman, M., & Kennedy, R. (March 2004). A comparison of buffered lidocaine versus ELA-max before peripheral intravenous catheter insertions in children. Pediatrics, 113(3), e217-e220. MacLean, S., Obispo, J., & Young, K. (February 2007). The gap between pediatric emergency department procedural pain management treatments available and actual practice. Pediatric Emergency Care, 23(2), 87-93. Pershad, J., Steinberg, S., & Waters, T. (October 2008). Cost-effectiveness analysis of anesthetic agents during peripheral intravenous cannulation in the pediatric emergency department. Archives of Pediatrics and Adolescent Medicine, 162(10), 952-961. Rossiter, K., Kontos, P., Colantonio, A., Gilbert, J., Gray, J., & Keightley, M. (2008). Staging data: Theatre as a tool for analysis and knowledge transfer in health resource. Social Science and Medicine, 66(1), 130-146. Schecter, N. (November 2008). From the ouchless place to comfort central: The evolution of a concept. Pediatrics, 122(Supplement 3), S154-S160. Simpson, F., & Gordon, D. (2007). The relative effectiveness of practice change interventions in overcoming common barriers to change: A survey of 14 hospitals with experience implementing evidence-based guidelines. Journal of Evaluation in Clinical Practice, 13, 709-715. Sirkin, H. L., Keenan, P., & Jackson, A. (October 2005). The hard side of change management, Harvard Business Review. http://hbr.harvardbusiness.org/2005/10/the-hard-side-of-change-management/sb1, date accessed 8/31/09. Tolson, D., Booth, J., & Lowndes, A. (2008). Achieving evidence-based nursing practice: Impact of the Caledonian development model. Journal of Nursing Management, 16, 682-691. Walco, G. (November 2008). Needle pain in children: Contextual factors. Pediatrics, 122(Supplement 3), S125-S129. Zempsky, W. (November 2008). Optimizing the management of peripheral venous access pain in children: Evidence, impact, and implementation. Ped, 122, S121-S124. Zempsky, W. (November 2008). Pharmacologic approaches for reducing venous access pain in children. Pediatrics, 122(Supplement 3), S140-S153. Zempsky, W., Cravero, J., & Committee on Pediatric Emergency Medicine, and Section on Anesthesiology and Pain Medicine. (November 2004). Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics, 114(5), 1348-1356. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]
Keywords:
Framework; Pediatric
Repository Posting Date:
16-Jan-2012
Date of Publication:
3-Jan-2012
Sponsors:
UTHSCSA Summer Institute

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleDevelopment of a Multidisciplinary Evidence-Based Framework for Sustaining Change in Pediatric Nursing Practiceen_GB
dc.identifier.urihttp://hdl.handle.net/10755/203234-
dc.description.abstract(Summer Institute) Problem: Despite many strong EBP models for initiating change in pediatric nursing practice, the challenge to sustain change over time remains. The purpose of this EBP project was to identify the most effective strategies to sustain change from a variety of different disciplines, develop them into a framework to change practice, and test the framework in two pediatric units using the problem of needle stick pain prevention. Evidence: Iowa model of EBP (Titler, 2001) guided this project. Extensive search of multidisciplinary on-line databases provided summary evidence from: 1) psychology: successful change related to congruent decisions, 2) neuroscience: changes in brain neuroplasticity related to repetition, 3) cognitive behavioral therapy: successful change and axiomatic rules, 4) business: guidelines for making change stick, 5) nursing: change related to cultural assessment. Strategy: This evidence was incorporated into an implementation framework with strategies for sustaining change in pediatric nursing practice. Practice Change: To pilot and evaluate the change framework, a multidisciplinary group of pediatric nurses and caregivers from the E.D. and post-surgical in-patient units were recruited for an EBP team to improve needle stick pain prevention (NSPP). Key stakeholders from various parts of the hospital participated, including a pharmacist and laboratory technician. Evaluation: Baseline data was collected by surveying healthcare providers regarding their perceived importance for the use of pain prevention measures prior to performing needle stick. Additional data collected included current pharmacological and non-pharmacological practice. The culmination of this data suggested that previous strategies to implement EBP for NSPP were inadequate. Results: Two year follow up shows increased use of pharmacological and non-pharmacological practices and increased patient/parent satisfaction with NSPP. Recommendations: Multidisciplinary evidence based strategies to help sustain change in practice can enhance adoption and help overcome barriers. Lessons Learned: Meaningful change takes time in a large organization. Early adopters and champions can help pave the way for areas slower to adopt new change. Identifying key stakeholders and best communication strategies enhances positive outcomes. Bibliography: Ales, R., May, D., & Whitney, L. (2007). A study comparing chloroprocaine with lidocaine for skin infiltration before intravenous catheter insertion. American Association of Nurse Anesthetists, 75(4), 255-258. Baxter, A., Ewing, P., Evans, N., Ware, A., Mix, A., & Manworren, R. EMLA application in triage improves venipuncture success, poster presentation, Children’s Medical Center, Dallas. Christensen, C. M., Marx, M., & Stevenson, H. H. (October 2006). The tools of cooperation and change. Harvard Business Review, http://hbr.harvardbusiness.org/2006/10/the-tools-of-cooperation-and-change/ar/1, date accessed 8/31/09. Cohen, L. (November 2008). Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics, 122(Supplement 3), S135-S139. Davies, R. J. (2003). Buffering the pain of local anaesthetics: A systematic review. Emergency Medicine, 15, 81-88. Du, S., Jaaniste, T., Champion, G. D., & Yap, C. S. L. (August 2008). Theories of fear acquisition: The development of needle phobia in children. Pediatric Pain Letter, 10(2). Ford, J. D., & Ford, L. W. (April 2009). Decoding resistance to change. Harvard Business Review. http://hbr.harvardbusiness.org/2009/04/decoding-resistance-to-change/ar/1, date accessed 8/31/09. Garvin, D. A., & Roberto, M. A. (February 2005). Change through persuasion. Harvard Business Review. http://hbr.harvardbusiness.org/2005/02/change-through-persuasion/ar/1, date accessed 8/31/09. Granger, B. Practical steps for evidence based practice. Advanced Critical Care Nursing, 19(3), 314-324. Grabe, M., Yegiyan, N., & Kamhawi, R. (2008). Experimental evidence of the Knowledge gap: Message arousal, motivation, and time delay. Human Communication Research, 34, 550-571. Grol, R. (May 2008). Knowledge transfer in mental health care: How do we bring evidence into day to day practice? Canadian Journal of Psychiatry, 53(5), 275-276. Hagel III, J., Brown, J. S., & Davison, L. The big shift: Measuring the forces of change. Harvard Business Review, http://hbr.harvardbusiness.org/2009/07/the-big-shift/ar/1, date accessed 8/31/09. Hammer, M. (April 2004). Deep change: How operational innovation can transform your company. Harvard Business Review, http://hbr.harvardbusiness.org/2004/04/deep-change/ar/1, date accessed 8/31/09. Kegan, R., & Lahey, L. L. (November 2001). The real reason people Won’t change. http://hbr.harvardbusiness.org/2001/11/the-real-reason-people-wont-change/ar/1, date accessed 8/31/09. Kennedy, R., Luhmann, J., & Zempsky, W. (November 2008). Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics, 122(Supplement 3), S130-S133. Ketelaar, M., Russell, D., & Gorter, J. W. (2008). The challenge of moving evidence-based measures into clinical practice: Lessons in knowledge translation. Physical and Occupational Therapy in Pediatrics, 28(2), 191-206. Kotter, J. P. Leading change: Why transformation efforts fail. Harvard Business Review. http://hbr.harvardbusiness.org/2007/01/leading-change/ar/1, date accessed 8/31/09. Kotter, J. P., & Schlesinger, L. A. (July-August 2008). Choosing strategies for change. Harvard Business Review, http://hbr.harvardbusiness.org/2008/07/choosing-strategies-for-change/ar/1, date accessed 8/31/09. Lander, J., Weltman, B., & So, S. (2006). AMLA and amethocaine for reduction of children's pain associated with needle insertion. Cochrane Database of Systematic Reviews 2006, Art. No. CD004236(3). Leahy, S., Kennedy, R., Hesselgrave, J., Gurwitch, K., Barkey, M., & Millar, T. (November 2008). On the front lines: Lessons learned in implementing multidisciplinary peripheral venous access pain-management programs in pediatric hospitals.122(Supplement 3), S161-S170. Litva, A., & Peters, S. (2008). Exploring barriers to teaching behavioral and social sciences in medical education. Medical Education, 42, 309-314. Luhmann, J., Hurt, S., Shootman, M., & Kennedy, R. (March 2004). A comparison of buffered lidocaine versus ELA-max before peripheral intravenous catheter insertions in children. Pediatrics, 113(3), e217-e220. MacLean, S., Obispo, J., & Young, K. (February 2007). The gap between pediatric emergency department procedural pain management treatments available and actual practice. Pediatric Emergency Care, 23(2), 87-93. Pershad, J., Steinberg, S., & Waters, T. (October 2008). Cost-effectiveness analysis of anesthetic agents during peripheral intravenous cannulation in the pediatric emergency department. Archives of Pediatrics and Adolescent Medicine, 162(10), 952-961. Rossiter, K., Kontos, P., Colantonio, A., Gilbert, J., Gray, J., & Keightley, M. (2008). Staging data: Theatre as a tool for analysis and knowledge transfer in health resource. Social Science and Medicine, 66(1), 130-146. Schecter, N. (November 2008). From the ouchless place to comfort central: The evolution of a concept. Pediatrics, 122(Supplement 3), S154-S160. Simpson, F., & Gordon, D. (2007). The relative effectiveness of practice change interventions in overcoming common barriers to change: A survey of 14 hospitals with experience implementing evidence-based guidelines. Journal of Evaluation in Clinical Practice, 13, 709-715. Sirkin, H. L., Keenan, P., & Jackson, A. (October 2005). The hard side of change management, Harvard Business Review. http://hbr.harvardbusiness.org/2005/10/the-hard-side-of-change-management/sb1, date accessed 8/31/09. Tolson, D., Booth, J., & Lowndes, A. (2008). Achieving evidence-based nursing practice: Impact of the Caledonian development model. Journal of Nursing Management, 16, 682-691. Walco, G. (November 2008). Needle pain in children: Contextual factors. Pediatrics, 122(Supplement 3), S125-S129. Zempsky, W. (November 2008). Optimizing the management of peripheral venous access pain in children: Evidence, impact, and implementation. Ped, 122, S121-S124. Zempsky, W. (November 2008). Pharmacologic approaches for reducing venous access pain in children. Pediatrics, 122(Supplement 3), S140-S153. Zempsky, W., Cravero, J., & Committee on Pediatric Emergency Medicine, and Section on Anesthesiology and Pain Medicine. (November 2004). Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics, 114(5), 1348-1356. [© Academic Center for Evidence-Based Practice, 2011. http://www.acestar.uthscsa.edu]en_GB
dc.subjectFrameworken_GB
dc.subjectPediatricen_GB
dc.date.available2012-01-16T11:04:55Z-
dc.date.issued2012-01-03en_GB
dc.date.accessioned2012-01-16T11:04:55Z-
dc.description.sponsorshipUTHSCSA Summer Instituteen_GB
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