Case

NUR 590: Evidence-Based Practice Dr. Johnsonius NUR 590 Final Paper

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Course
NUR 590

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NUR 590

Section A: Organizational Culture and Readiness Assessment The assessment the learner used to ascertain her organization’s readiness for evidencebased practice (EBP) implementation was a shortened version of the OCRSIEP. The OCRSIEP was developed to help offer insights into an organization’s ...

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Evidence-Based Practice Proposal Final Paper

Melissa Han

College of Nursing and Health Professions, Grand Canyon University

NUR 590: Evidence-Based Practice

Dr. Johnsonius

July 7, 2021

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Abstract

According to the Centers for Disease Control and Prevention (CDC), suicide was the tenth

leading cause of death in the United States in 2019 (National Institute of Mental Health, 2021).

Many factors contribute to this statistic, but the learner will be focusing on the barriers that in-

person psychiatric treatment has posed especially in the past year in the midst of the Covid-19

pandemic and need for social distancing. In-person psychiatric treatment barriers include waiting

times, transportation difficulties and concerns of mental health stigma (Alavi & Hirji, 2020)

which contribute to poor patient follow-up and thus poorer mental health outcomes. The

learner’s proposed evidence-based practice (EBP) solution intends to implement internet-based

cognitive behavioral therapy (eCBT) within her organization’s mental health practice to help

overcome these barriers. In this paper the learner will discuss the process she underwent to

research, implement, disseminate, and evaluate her proposal.

, 3

Section A: Organizational Culture and Readiness Assessment

The assessment the learner used to ascertain her organization’s readiness for evidence-

based practice (EBP) implementation was a shortened version of the OCRSIEP. The OCRSIEP

was developed to help offer insights into an organization’s baseline readiness to integrate EBP

into their clinical practice (Yoo et al., 2019). The learner performed the assessment on three

different units of a large, inner-city teaching hospital – the emergency department, post-

anesthesia care unit and medical intensive care unit. Results showed barriers included lack of

staff nurses who have strong EBP skills and advanced practice nurses (APNs) to mentor staff

nurses. Facilitators of EBP integration included skilled librarians and a strong organizational

push towards fostering EBP culture.

The rationale for the high-scoring categories include the organization’s goal of applying

for Magnet status within the next five years and having dedicated library staff that are well-

versed in research strategies and EBP. The rationale for the low-scoring categories include lack

of time and/or interest in EBP due to burnout, lack of management support in terms of dedicating

time for staff nurses to perform EBP on the unit and nurses not confident in EBP research skills.

Although the organization hopes to apply for Magnet status soon, nurses feel that there is not an

organized effort in fostering a spirit of inquiry among the organization.

A strategy the learner’s organization can adopt to help overcome these barriers and

integrate clinical inquiry into the organization include establishing a mentorship program.

Research shows that formalized mentorship programs between APN’s and staff nurses can help

foster EBP knowledge, skills and beliefs (Spiva et al., 2017). This program should be supported

by upper management, such as the chief nursing officer, and details approved by those

knowledgeable in EBP principles and leadership development such as clinical nurse leaders. If

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such a program took place in the learner’s organization, she believes that more nurses will be

comfortable with performing EBP research and will foster a spirit of inquiry throughout the

organization.

Section B: Proposal/Problem Statement and Literature Review

Traditional in-person cognitive behavioral therapy (CBT) has many barriers that lead to

poor patient follow-up and thus poorer mental health outcomes. The learner’s PICO question is

whether internet-based CBT (eCBT) is more effective at reducing suicidal risk in young adults,

aged 18 to 25, versus traditional in-person treatment. In-person CBT is proven to be an effective

and evidence-based treatment for suicide prevention (Brodsky et al., 2018) but the need for

virtual solutions has increased. Not only has the Covid-19 pandemic increased this need but also

in-person treatment barriers such as transport and wait times, concerns mental health stigma and

cost lead to decreased follow-up appointments (Olmos-Ochoa et al., 2020).

The literature review the learner performed consisted of five randomized controlled trials

(RCTs) to help support the PICO question. RCTs were chosen because they are a well-

established primary source of research. The methods they researchers used in the study

established a single-blind study with control and intervention groups which ensured no bias and

accurate results. In the intervention groups variations of eCBT were utilized such as a technician-

assisted eCBT program (Rosso et al., 2016) and self-guided eCBT programs (Löbner et al.,

2018). The control groups were offered various in-person alternatives such as treatment as usual

(Rosso et al., 2016; Hetrick et al., 2017; Kladnitski et al., 2020), mental health support services

(Pugh et al., 2016) or follow-ups with their primary physician (Löbner et al., 2018).

The subjects of the five studies ranged from various age groups with the main similarity

of scoring highly on a depression/suicidal ideation inventory. The studies included specialized

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