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Week 9 Barriers to Realization of Desired Outcomes Responses

Hi, please if you could reply to the following discussion questions with a 100-150 word response. Thank youMargot, My EBP project is to use early SSC (skin-to-skin contact) immediately following delivery of a term, healthy newborn to facilitate breastfeeding and newborn/parental bonding. There are numerous organizational barriers that could impact this proposed EBP change proposal from continuing to achieve the desired results long term. My main concern is that with our high Hispanic patient population in our unit, many don t have the incentive to breastfeed for many reasons. These include socioeconomic, cultural, and educational reasons. For example, dual breast and bottle feeding in the Hispanic culture is very common, even when the infant is very young. Also,their fear of the newborn becoming cold if it isn t swaddled in numerous layers could be a deterrent. Re-education will take time and patience and some nurse colleagues won t bother to do this and just let them do things the way they want to. Another barrier is the volume of patients in our unit is expected to increase substantially in the next year and delaying routine nursing intervention post delivery to allow the SSC may not be feasible for every delivery. Re-education of patients and staff of the benefits of this intervention (starting at their clinic prenatal visits) and collaborating with our unit s lactation consultants to promote this practice are some possible strategies to continue this proposed change. I think just empathizing how simple and effective it is to both staff and patients will be important and it will become routine in time. Time will tell!Chiamaka, The evidence-based practice (EBP) process starts with a clinical question and then proceeds to searching and critically appraising the evidence. The last step in EBP is to evaluate the outcomes and disseminate the results. Successful implementation and diffusion of any practice change requires careful strategic planning. My EBP change proposal is on wound care management. The overall aim of wound management is to promote wound healing. Both patients and health professionals, for different reasons, want wound closure to occur as quickly as possible.There are many reasons or barriers why implementation of effective wound care practice might not continue to obtain the same desire from 6 months to a year from now. One barrier is, the personal experience and opinion of colleagues continues to be a dominant in uence in wound care with many practitioners relying on a small range of treatment approaches with which they have received good results in the past. Another barrier is that expert opinion varies greatly in different countries and between discrete professional groups, resulting in con icting advice and different practice recommendations. Contradictory ndings from different sources present a challenge for the wound care practitioner who needs unambiguous solutions to practical problems.Educational strategies need to be speci cally targeted to meet the needs of different professional groups and levels of expertise to maximize effectiveness. An example of this would be the appropriate preparation of clinical leaders such as specialist nurses so that they are equipped with the skills, knowledge and attitudes to disseminate and implement evidence-based wound care locally. This also helps to create effective role models as health professionals are more likely to implement the good practice demonstrated by a colleague than good practice read about in a journal (Lucker and Kenrick, 1995; Boxter and Maynard, 1999).ReferencesBoxter E., Maynard C. (1999) The management of chronic wounds: factors that affect nurses decision-making. J Wound Care 8(8): 409 12Lucker K.A., Kenrick M. (1995) Towards knowledge-based practice: an evaluation of a method of dissemination. Int J Nurs Stud 32(1): 59 67Catherine, Barriers to my EBP change proposal of turn teams and turn devices are compliance and budget. Barriers to turn teams is competing priorities. It s difficult to stop what you are doing and help another person turn. Budget is an issue to. The turn device sensors are approximately $200 a piece and are not reusable. This is a barrier I may not be able to overcome. But using wedges and signoff sheets maybe another way to keep track of turns and ensure adequate turning unless contraindicated. To overcome compliance with turn teams, I plan to come up with variations. Such as other than signing up for time slots to turn, nurses use the buddy system and they turn their respective patients together. Of course, if there is a change in a patient s condition, everyone else needs to step up and help each other which isn t an issue.

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