DNP 820 Implementation Into Practice GCU
Healthcare facilities, irrespective of their size, mission, or specific programs, are mandated to deliver timely, safe, and high-quality care. This standard obligation necessitates the application of multi-dimensional interventions to address the diverse needs of patients.
The translation of research into clinical practice plays a vital role in promoting Evidence-Based Practice (EBP), contributing to innovative problem-solving approaches that can mitigate adverse health outcomes (Wensing & Grol, 2019).
The significance of this process compels healthcare practitioners and organizational leaders to implement programs that bridge the gap between research findings and clinical practice.
Implementation of DNP 820 Concepts in Clinical Practice at GCU
Therefore, healthcare facilities must embrace change and provide robust support for evidence-based practice (EBP). The focus of this paper is to explore a specific area where a gap exists between research findings and their effective implementation into practice, particularly in the context of Doctor of Nursing Practice (DNP) education.
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Topic, Supporting Research, and Desired Outcomes
The Agency for Healthcare Research and Quality (AHRQ) addresses various health topics relevant to contemporary nursing practice. A subject linked to the Direct Practice Improvement (DPI) project is hospital readmissions, recognized as a priority by payers, providers, and policymakers aiming to enhance health outcomes while reducing costs (AHRQ, n.d.). Hospital readmissions are pertinent to the DPI project, as their occurrence impedes the quality improvement in healthcare at the practicum site. Notably, pressure ulcers contribute significantly to hospital readmissions, hospitalizations, and elevated costs (Wassel et al., 2020). Any notable increase in pressure ulcers leads to a proportional rise in hospital readmissions, thereby compromising the quality of care.
Hospital readmissions have a detrimental impact on health outcomes, necessitating evidence-based, sustainable, and pertinent solutions. Recent health data reveals an annual expenditure of over $52.4 billion on readmitted patients (Beauvais et al., 2022). Without the implementation of enduring programs by healthcare organizations, these costs are poised to escalate over time. Upadhyay et al. (2019) observed that readmission penalties surpass half a billion dollars annually, posing a threat to the growth and sustainability of organizations committed to providing safe and quality care. Additionally, critical aspects of quality sustainability, such as organizational reputation and partnerships, become compromised when hospital readmission rates are high. Patient-provider relationships are strained due to a decrease in patient trust in healthcare professionals.
Given that pressure ulcers heighten the risk of readmissions, their prevention should be a top priority for all hospitals. The translation of research into practice entails the implementation of interventions supported by scientific evidence. Veith et al. (2019) underscored the importance of a comprehensive approach to wound care strategies, patient education in nursing, and modifying risk factors to prevent pressure ulcers. Essential wound care strategies encompass preventive dressing, patient repositioning, and meticulous wound cleaning for admitted patients. These strategies form integral components of a preventive pressure bundle that has demonstrated high efficacy in reducing the incidence of pressure ulcers in critical care settings (Darvall et al., 2018; Hahnel et al., 2020). The implementation of such a bundle would be pivotal in reducing readmission rates in the current healthcare setting.
Healthcare professionals strive to integrate research into clinical practice with the aim of enhancing health outcomes. The primary objective of applying research in wound care is to mitigate pressure ulcers, leading to a proportional decrease in hospital readmissions. This reduction in readmissions not only cuts healthcare costs but also enhances the organization’s capacity to invest in quality care programs. Patient trust in healthcare professionals, as highlighted by Rasiah et al. (2020), hinges on the quality of care and healthcare experiences. Therefore, the implementation of a care bundle and other wound care initiatives is crucial for improving patient-provider relationships and fostering trust in healthcare professionals. The impact of high hospital readmissions extends to organizational reputation, emphasizing the importance of implementing research to elevate the organization’s standing and foster growth (Upadhyay et al., 2019).
Extent of Research Implementation
ProMedica Skilled Nursing and Rehabilitation (Wheaton), as an established healthcare institution, has instituted various programs to optimize patient outcomes, including patient education, telehealth in nursing, follow-up care, and testing new treatments and care models (ProMedica, 2021). However, a notable gap between research findings and their practical application exists, primarily evidenced by the facility’s heavy reliance on routine pressure ulcer prevention care. To address this disparity, there is a need for substantive improvement through the implementation of more evidence-based interventions. Particularly, interventions targeting high-risk groups such as the elderly and debilitated patients are essential to reduce the incidence of pressure ulcers and associated adverse outcomes like hospital readmissions, mortality, and hospitalization.
Possible Barriers to Implementation
Implementing a preventive bundle to address pressure ulcers and hospital readmissions in the facility faces various barriers, including resource facilitation, availability of implementation team members, and patients’ reluctance to participate. Resource inadequacy is a significant challenge, as effective implementation requires technologies like patient monitors and alert systems. Additionally, collaborative teamwork is essential, but the intensity of nursing care may affect the availability of staff for successful research implementation.
Possible Ways to Overcome the Barriers
Overcoming these barriers necessitates active stakeholder engagement, providing them with comprehensive information about the translating research into practice and its potential benefits. This engagement process influences stakeholders positively, garnering their support for change. Another potential intervention is the implementation of affordable components of a preventive bundle, such as patient repositioning and optimizing turns. Intensive patient education in nursing is crucial to improving health literacy, increasing patient confidence in the project, and ensuring active participation and compliance.
Resources Available on the Site
ProMedica Skilled Nursing and Rehabilitation (Wheaton) benefits from various resources, including a well-equipped health workforce, modality-based equipment, comfortable surroundings, and essential tools like the internet (ProMedica Health System, 2022). These resources play a vital role in facilitating the translation of research into practice, ensuring the protection and comfort of research subjects.
Conclusion
Continuous quality improvement is a commitment that healthcare facilities should uphold. This involves ongoing research translation into practice and continual assessment of outcomes. While ProMedica Skilled Nursing and Rehabilitation (Wheaton) has made significant investments in care quality improvement, additional interventions are imperative to reduce hospital readmissions. The implementation of research on interventions for pressure ulcer prevention, including wound care strategies, patient education, and risk assessment, will be pivotal in achieving this goal.
References
AHRQ. (n.d.) Hospital readmissions. https://www.ahrq.gov/topics/hospital-readmissions.html
Beauvais, B., Whitaker, Z., Kim, F., & Anderson, B. (2022). Is the hospital value-based purchasing program associated with reduced hospital readmissions? Journal of Multidisciplinary Healthcare, 15, 1089–1099. https://doi.org/10.2147/JMDH.S358733
Darvall, J. N., Mesfin, L., & Gorelik, A. (2018). Increasing frequency of critically ill patient turns is associated with a reduction in pressure injuries. Critical Care and Resuscitation, 20(3), 217-222. https://europepmc.org/article/med/30153784
Hahnel, E., El Genedy, M., Tomova‐Simitchieva, T., Hauß, A., Stroux, A., Lechner, A., … & Kottner, J. (2020). The effectiveness of two silicone dressings for sacral and heel pressure ulcer prevention compared with no dressings in high‐risk intensive care unit patients: A randomized controlled parallel‐group trial. British Journal of Dermatology, 183(2), 256-264. https://doi.org/10.1111/bjd.18621
Haynes, S. C., Rudov, L., Nauman, E., Hendryx, L., Angove, R. S., & Carton, T. (2018). Engaging stakeholders to develop a patient-centered research agenda: Lessons learned from the research action for health network (REACHnet). Medical Care, 56(10 Suppl 1), S27-S32. doi: 10.1097/MLR.0000000000000785
ProMedica. (2021). Your health. Our mission. https://www.promedica.org/redefining-healthcare/#
ProMedica Health System. (2022). ProMedica Skilled Nursing and Rehabilitation. https://www.promedicaskillednursing.org/locations/promedica-skilled-nursing-and-rehabilitation-wheaton/?contentIdString=14063
Rasiah, S., Jaafar, S., Yusof, S., Ponnudurai, G., Chung, K. P. Y., & Amirthalingam, S. D. (2020). A study of the nature and level of trust between patients and healthcare providers, its dimensions and determinants: A scoping review protocol. BMJ Open, 10(1), e028061. http://dx.doi.org/10.1136/bmjopen-2018-028061
Upadhyay, S., Stephenson, A. L., & Smith, D. G. (2019). Readmission rates and their impact on hospital financial performance: A study of Washington Hospitals. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 56, 46958019860386. https://doi.org/10.1177/0046958019860386
Veith, J. P., Collier, W., Kim, J., Agarwal, J., & Kwok, A. (2019). A national analysis of readmissions for wound healing complications following the repair of lower back, hip, and buttock pressure ulcers using the Nationwide Readmissions Database. The American Journal of Surgery, 217(4), 658-663. https://doi.org/10.1016/j.amjsurg.2018.12.013
Wassel, C. L., Delhougne, G., Gayle, J. A., Dreyfus, J., & Larson, B. (2020). Risk of readmissions, mortality, and hospital‐acquired conditions across hospital‐acquired pressure injury (HAPI) stages in a US National Hospital Discharge database. International Wound Journal, 17(6), 1924-1934. https://doi.org/10.1111/iwj.13482
Wensing, M., & Grol, R. (2019). Knowledge translation in health: How implementation science could contribute more. BMC Medicine, 17(1), 1-6. https://doi.org/10.1186/s12916-019-1322-9
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