Evidence-Based Practice and the Workplace Environment

Topic: Nursing
Words: 1203 Pages: 5

Healthcare organization

Based on the workplace environment assessment, the workplace civility score is 82; this rating indicates a reasonably healthy work environment. Even if the organizational structure has specific beneficial characteristics, the corporate culture is not evaluated regularly and does not represent the organizational goal; hence, the culture lacks uniformity among units. Ineffective conflict resolution skills are a significant issue. Employees who had disagreements did not find the settlement successful since they still had the same problems. Despite the organization’s extensive mentorship program, new nurses find it ineffective. According to the nurses, their mentors do not have time to teach them. The nurse-patient ratio is clearly out of balance due to ongoing staffing challenges. Additionally, there are flaws in team norm compliance and informal leadership. The organization needs a change and is ready for a change.

Opportunity for change: Shared decision-making

Based on the scope of the issue, it is necessary to solve conflicts and balance the workload. Havaei and MacPhee (2020) emphasize that patients and their families are often unsatisfied with nurses’ incapacity to give appropriate care owing to unbalanced workloads. Nurses and mentors should adopt a root cause analysis strategy when dealing with patient/family difficulties. While most healthcare programs rely on nurse staffing levels as the only unit-level workload indicator, new solutions must focus on workload indicators that go beyond nurse-patient ratios. Thus, the opportunity for change in the current organization includes shared decision-making. Patients, nurses, and EBP mentors are among the stakeholders participating. According to Melnyk and Fineout-Overholt (2018), enhanced EBP beliefs in clinicians lead to more evidence-based practice applications, resulting in higher job satisfaction, less staff turnover, and improved patient outcomes. EBP mentors are critical stakeholders in implementing change (Melnyk et al., 2017). Consequently, through deliberate strategic efforts, they assist point-of-care professionals in improving their thoughts about the utility of EBP and their confidence in using it.

Essentially, there are several risks associated with change implementation in general. First, the time needed is one of the most often stated impediments to SDM deployment (Schroy et al., 2011). According to Kon et al. (2016), critical care organizations support shared decision-making; yet, there is still uncertainty regarding what shared decision-making is, when it should be utilized, and how to build partnerships in treatment choices. In contrast, because it has its roots in clinical epidemiology, much of the focus of evidence-based medicine (EBM) has been on tools and resources to help with discovering, evaluating, and synthesizing data (Hoffman et al., 2014). There has been far less emphasis on discussing this data with patients and involving them in its use. Most EBM, attention has focused on crises and high-tech milestones, such as systems to make EBM better and more accessible (Hoffman et al., 2014). Hence, There has been a scarcity of information regarding utilizing evidence in patient decision-making.

Evidence-based idea for a change

Evidence-based medicine should start and finish with the patients; they are the most vital shareholders. Shared decision-making is a collaborative process in which patients or their representatives and practitioners make healthcare decisions jointly, considering evidence-based practice and the patient’s interests and objectives (Kon et al., 2016). Hoffman et al. (2014) acknowledge that after gathering and evaluating evidence and incorporating its implications with their knowledge, practitioners should seek to make a decision that represents their patient’s values and circumstances. Shared decision-making is the junction of patient-centered effective communication and EBM at the pinnacle of effective patient care (Hoffman et al., 2014). Moreover, genuine EBM cannot occur in the absence of SDM. EBM can devolve into evidence tyranny in the absence of collaborative decision-making. Integrating SDM skill training into evidence-based practice training is a reasonable starting point.

Notably, an example of shared-decision making is patient decision aids. Patient decision aids are particular tools that help patients be active in decision-making by making the choice that has to be addressed explicitly, offering information about alternatives and consequences, and defining values and beliefs (The Ottawa Hospital, n.d.). These tools are intended to supplement, rather than replace, professional medical advice. The patient decision aids are founded on evidence-based practice; for instance, using the Cochrane review methodology, an international research group maintains the systematic analysis of trials of patient decision aids for treatment or screening choices (The Ottawa Hospital, n.d.). Schroy et al. (2011) state that it is critical to involve patients in decision-making when faced with preference-sensitive options linked to cancer screening or treatment. Moreover, decision aids can help SDM increase patient-provider contact quality and efficiency and allow users to participate in the decision-making process.

Plan for knowledge transfer

The plan for knowledge transfer of shared decision-making, namely patient decision aids, includes knowledge creation, dissemination, and organizational adaptation and implementation. The dissemination strategy is focused on training EBP professionals to serve as future advisors. According to Newhouse et al. (2007), leadership is fundamental for preparing organizations for change. Furthermore, strong leadership will enhance both patient and staff safety. Thus, leadership endorsement will assist in solving disputes. Nurse schedules have to be adjusted to allow time away from clinical tasks for initial training (Newhouse et al., 2007). Hence, committee members may give training and assistance to any department that has completed initial training.

Dissemination strategy

Explanation of how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.

The ARCC Model was employed to select the dissemination strategy. According to Melnyk et al. (2017), the Clinical Practice through Close Collaboration (ARCC) Model is a system-wide method for building and sustaining EBP in healthcare organizations. The dissemination strategy includes training EBP experts to function as future consultants. These people are supposed to be the key proponents and enablers of EBP and SDM. Fostering EBP inside organizations requires a solid framework, which involves nursing leadership and personnel, and material resources (Newhouse et al., 2007). Additionally, the ARCC Model is built around a critical mass of EBP mentors.

Measurable outcomes

Essentially, the primary goal is to increase the return on investment for SDM. Opperman et al. (2018) suggest that professional development activities are typically designed based on needs assessments, conducted using evidence-based learning modalities, and assessed for efficacy through outcomes connection. Consequently, the economic effect of professional development initiatives is the next level of evaluation. The measurement outcomes I hope to achieve with the implementation of patient decision aids are reduced infection rates, pressure injuries, and length of patients’ stay at the hospital. Moreover, the goal is to increase personnel knowledge and confidence in high-risk procedures via training.

Lessons learned

I have learned that by assessing the environment by completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template, it is possible to identify the organizational problems. Additionally, the Assessment helps me select relevant articles for developing suitable solutions to solve the current issues. For instance, inefficient conflict resolution skills can be solved by applying a root cause analysis method (Havaei & MacPhee, 2020). Consequently, the efficient communication between nurses and patients, namely the shared making (SDM), is vital to dispute the conflicts because, without SDM, evidence-based practice cannot occur. Training is necessary to disseminate knowledge across the organization (Melnyk et al., 2017). Consequently, the success of the SDM can be measured by ROI for SDM activities.


Garcia, C. D. L., Abreu, L. C. D., Ramos, J. L. S., Castro, C. F. D. D., Smiderle, F. R. N., Santos, J. A. D., & Bezerra, I. M. P. (2019). Influence of burnout on patient safety: Systematic review and meta-analysis. Medicina, 55(9), 553. Web.

Havaei, F., & MacPhee, M. (2020). The impact of heavy nurse workload and patient/family complaints on workplace violence: An application of Human Factors Framework. Nursing Open, 7(3), 731–741. Web.

Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295–1296. Web.

Junttila, J. K., Koivu, A., Haatainen, K., & Haatainen, P. (2019). Nurse-assessed optimality of workload-A valid measure for the adequacy of nursing resources. Online Journal of Nursing Informatics, 23(3). Web.

Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared decision making in intensive care units: An American College of Critical Care Medicine and American Thoracic Society policy statement. Critical Care Medicine, 44(1), 188–201. Web.

Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.

Melnyk, B. M., Fineout-Overholt, E., Giggleman, M., & Choy, K. (2017). A test of the ARCC© model improves implementation of evidence-based practice, healthcare culture, and patient outcomes. Worldviews on Evidence-Based Nursing, 14(1), 5–9. Web.

Newhouse, R. P., Dearholt, S., Poe, S., Pugh, L. C. & White, K. M. (2007). Organizational change Strategies for evidence-based practice. JONA: The Journal of Nursing Administration, 37(12), 552-557. Web.

Opperman, C., Liebig, D., Bowling, J., & Johnson, C. S., & Harper, M. (2016). Measuring return on investment for professional development activities: Implications for practice. Journal for Nurses in Professional Development, 32(4), 176–184. Web.

Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35. Web.

The Ottawa Hospital Research Institute. (2019). Patient decision aids. Web.

Vaismoradi, M., Tella, S., A Logan, P., Khakurel, J., & Vizcaya-Moreno, F. (2020). Nurses’ adherence to patient safety principles: A systematic review. International Journal of Environmental Research and Public Health, 17(6), 2028. Web.

Incivility in the Nursing Profession
Researching of Culturally Competent Nursing