Week 6 Assignment: EBP Change Process form

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Week 6 Assignment: EBP Change Process form
ACE Star Model of Knowledge Transformation
Star Point 1: Discovery (Identify topic and practice issue)
Identify the topic and the nursing practice issue related to this topic. (This MUST involve a nursing
practice issue.)
This paper would focus on the topic of patient safety and the effective ness of proper nurse to patient ratio
to enhance the patient safety.
Briefly describe your rationale for your topic selection. Include the scope of the issue/problem.
Rationale
In the past few years there had been an increasing needs for the registered nurses in the hospitals due to
the high acuity of the patients and the shorter lengths of the patient stay in the hospitals. The safety and
the quality of the patient care is directly related to the hospital staffing and the experience of the nursing
workforce (McGahan et al., 2012).
In many of the clinical settings it has been noticed that the inpatient working condition has deteriorated as
the hospitals are not keeping up with the rising demands of the nurses (Cho et al., 2015). A constant nurse
vigilance at the bedside is necessary to ensure patient safety. There are several seminal studies that have
documented the increased risk of the patient safety events, the mortality and morbidity as the number of
patients increases (Aiken et al., 2012).
It is the nurse to patient ratio that is only one aspect of the relationship between the nursing workload and
the safety of the patient. Low nurse –to patient ratio has been associated with increased stress workload
and interruptions and the risk of burnout due to the involvement in the medical errors or the exposure to
any disruptive behavior (You et al., 2013).
Scope of research
The scope of research includes researches about the appropriate nurse to patient ratios supported by the
federal laws to ensure the safety of the patient.

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Star Point 2: Summary (Evidence to support need for a change)
Describe the practice problem in your own words and formulate your PICOT question.
The main practice problem of this assignment is the nurse –to patient ratio and its effectiveness in
enhancing the patient safety.
PICO – Does appropriate nurse- to patient relationship increases patients safety in clinical settings.
P- Hospital inpatients
I (interventions)- Proper nurse to patient ratio.
C (comparison)- shortage of staffing
O (Outcome)- Patient safety
List the systematic review chosen from the Cochrane Database of Systematic Reviews from the
Chamberlain library. Type the complete APA reference for the systematic review selected.
Shekelle, P. G. (2013). Nurse–patient ratios as a patient safety strategy: a systematic review. Annals of
Internal Medicine, 158(5_Part_2), 404-409.
List and briefly describe other sources used for data and information. List any other optional scholarly
source used as a supplement to the systematic review.
Electronic search has been conducted to find relevant papers and data has been collected from
government websites.
List of the important websites:-
https://www.nmc.org.uk/about-us/policy/position-statements/safe-staffing-guidelines/
https://www.nmc.org.uk/globalassets/sitedocuments/press/safe-staffing-position-statement.pdf

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https://www.evidence.nhs.uk/search?q=Nurse%20patient%20Ratio
Briefly summarize the main findings (in your own words) from the systematic review and the strength of
the evidence.
This paper had reviewed the evidence about the nursing staffing ratios and the in-hospital death through
September 2012. From 550 studies, 87 articles have been chosen and 15 new studies that augmented the
existing two reviews were selected from the studies. The strongest evidence supporting the relationship
between the nurse staffing level and a decreased inpatient mortality. None of the studies have reported
any serious harm in increasing the nurse staffing (Shekelle, 2013).
The cross sectional studies in the intensive care unit and the post-surgical settings has supported a causal
relationship between increased staffing level and decreased patient mortality. Two relevant systematic
reviews has been included to assess the benefits and risks of increasing the staffing levels. Lower rates of
nosocomial infections, pulmonary failure, failure to rescue, unplanned intubation were related to higher
RN staffing (Shekelle, 2013).
Some of the limitations that can be perceived form the literature review is that the review was restricted to
studies that used the hospital related mortality as the outcome. There was a lack of rigorous evaluation,
low response rates to the surveys that collect explanatory variables.
Outline one or two evidence-based solutions you will consider for the trial project.
One of the important evidence based solution to manage the nurse staffing for managing the nurse- to
patient ratio are restricting the unsafe floating of the nurse staffs. Temporary trained nurses will be
appointed to check the health outcomes of the patient (Cho et al., 2015). A detailed orientation and the
competence level of the staffs should be assessed before assigning a nurse to a clinical area. Any
temporary nursing professionals appointed should also get the same orientation and the competency
determination as the permanent staffs.
Another evidence based intervention is to develop a patient classification system and additional nursing
staffs should be added to the minimum ratio based on the documented classification system
Star Point 3: Translation (Action Plan)

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Identify care standards, practice guidelines, or protocols that may be in place to support your intervention
planning (These may come from your organization or from the other sources listed in your Summary
section in Star Point 2).
1. One of the safe staffing guidelines has been given by the Nursing and the midwifery Council of
United Kingdom. As per the guidelines, the nurse to –patient ratio in the critical care unit should
be 1.2 or less and the nurse –to patient ratio in an emergency department should be 1:4 or less at
all times that the patients are receiving the treatment. Secondly all the nursing staffs should be
registered with the NMC to practice as the nurse or the midwife (NMC, 2014).
2. The NICE guidelines for the hospital staffing capacity and capability. Again the National Quality
Board’s (NQB) guidance can also be followed to deliver the right staff, with the desired skills for
delivering the patient care. NICE has also published guidelines on the safe maternity staffing for
the maternity settings (National Institute for Health and Care excellence, 2017).
List your stakeholders (by title and not names; include yourself) and describe their roles and
responsibilities in the change process (no more than 5).
Appropriate staffing is a collective accountability of the executive teams and the boards.
Main stakeholders – The registered nurses who are working in the inpatient setting. Then can identify the
workload or the unmet needs of the patient or any problem arising due to less workforce.
The doctors- They can identify if any medical errors have occurred due to shortage of nursing staffs.
The clinical manager/ clinical officer- The clinical mangers would validate the needs of the nurses in the
inpatient ward.
The hospital board- The hospital board is responsible for assessing the registration and the qualification
of the recruited nurses.
Being a nurse, I should be able to point out the unmet needs or the adverse outcomes of shortage of the
nursing staffs.
What specifically is the nursing role in the change process?