Evidence Based Practice

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Change Management

Contents
Introduction…………………………………………………………….3 Evidence Based Practice……………………………………………….4 Clinical Governance…………………………………………………...5-6 Findings from the literature……………………………………………6-7 Implementing the change………………………………………………7-9 Leadership…………………………………………………………….9-10 The Un-freezing Stage………………………………………………10-11 The Moving Stage…………………………………………………...11-13 The Re-freezing Stage……………………………………………….13-15 Resistance and barriers to change…………………………………...15-16 Conclusion…………………………………………………………..16-17 References…………………………………………………………..18-24 Appendices………………………………………………………….25-26

Introduction

This is essay is being written to identify and promote change in clinical practice in relation to nursing and evidence based practice. This will be done in relation to nursing and will include supporting references. The literature review investigated nurses’ knowledge of pain management, finding that nurses’ had different ideas of what pain management is. Therefore the aim of the essay is to change practice by increasing nurses’ awareness of what exactly pain management is and from this how it can improve postoperative pain management in the clinical area.

This essay commences with a description of both clinical governance and evidence based practice (EBP) and the association between them, describing how this will assist achievement of clinical effectiveness. From this there will be a synopsis of the findings from a recent literature review of “Nurse Assessment and Management of Postoperative Pain” including a recommendation that was found from the evidence of this review and how this will have an impact for a change in practice. An analysis of different theories of change will be made, looking at several models and theorists. The chosen model for change will be used to bring the findings from the review into practice and what resources will be needed for the implementation of change and any barriers that may occur during the change process. All names and locations will be changed to maintain confidentiality in accordance with the Nursing and Midwifery Council (NMC) Code of Conduct (2008).

Evidence Based Practice

Evidence-based practice has been described as a systematic process of 'finding, appraising and using research findings as the basis for clinical decisions' (Long and Harrison, 1996 cited in McSherry et al, 2002, p7). However there are many other definitions the most widely used is Sackett et al (1996) "The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” However there are some problems with this definition especially with regards to nursing. This definition does not include what the patient wants from the care given. Morton and Morton (2003) agree that patients should be involved in decisions about their care. Therefore there is an alternate definition more suited to nursing that states "an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits the patient best" (Muir Gray, 1997). Simmons (2002) supports this view and states that for research to be of benefit it needs to be individualised to the patient. According to Morton and Morton (2003) this definition highlights that the nurse should integrate the patients preferences and their wish to avoid risk associated with some interventions and using the best available evidence for said interventions. More recently, Gerrish et al (2010) suggests that for nurses to give the best possible care to patients they need to research the evidence available and apply it to their decision-making in clinical practice.

Clinical Governance
Clinical Governance is an umbrella term that covers activities that help sustain...
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