临床导入与成效评价方月燕PhDRN辅英科技大学护理系课件

臨床導入

與

成效評估方月燕,Ph.D.,RN輔英科技大學護理系臨床導入

與

成效評估方月燕,Ph.D.,RN1影響臨床導入的因素組織支持人力、物力資源員工對組織的承諾跨團隊組織的功能Yueh-YenFang影響臨床導入的因素組織支持Yueh-YenFang2成功導入要件具備相信EBP能使病人照護成效最佳化之文化每一行政層級均具備有力領導協助各項資源提供(human,technology,andfinance)將EBP明確納入標準設置及工作職責中。Yueh-YenFang成功導入要件具備相信EBP能使病人照護成效最佳化之文化Yue3執行臨床導入的知識與技能領導者須具備的知識與技能改變理論（ChangeTheory）激勵理論（Motivationaltheory）知悉政治（Politicalsavvy）組織過程（Organizationalprocess）權力運作（Dynamicsofpower）Yueh-YenFang執行臨床導入的知識與技能領導者須具備的知識與技能Yueh-Y4執行臨床導入的知識與技能個人能安全、適當、有效使用實證所需的知識與技能基本研究知識運用研究結果及實證照護的知識與技能推論性統計的知識與解讀能力，和將研究結果運用於個人層面。探究範圍的專業知識Yueh-YenFang執行臨床導入的知識與技能個人能安全、適當、有效使用實證所需的5JHNEBP臨床導入流程Step1:決策該實證建議導入特定單位的適當性及可行性Step2:建立行動計畫Step3:進行改變Step4:評估成效Step5:向組織決策者報告初階成效Step6:贏得組織決策者對正式導入改變的支持Step7:指出下一步計畫Step8:溝通成效Yueh-YenFangJHNEBP臨床導入流程Step1:決策該實證建議導入6Step1:適當性及可行性Stetler(2001)實證標準Thefinding’sconsistencyQualityQuantity單位適合性組織內容與結構

（設備資源、改變能力、組織準備度、需求狀況、護理過程、政策、人員能力）可行性實證是否能有效改善問題目前的臨床操作Yueh-YenFangStep1:適當性及可行性Stetler(2001)Y7Step1:適當性及可行性需思考的問題…這項改變是否可改善臨床或管理成效？增進內、外部顧客滿意度降低照護或管理支出Yueh-YenFangStep1:適當性及可行性需思考的問題…Yueh-Yen8Step2:行動計畫行動計畫內容實施及評值的計畫書、指引、臨床路徑或系統/流程時程表組織領導者、臨床專業人員及機構投資者對計畫書的看法Yueh-YenFangStep2:行動計畫行動計畫內容Yueh-YenFang9Step2:行動計畫考慮阻礙及組織對改變的準備度足夠的人力、物力資源目前的工作流程組織決策者（個人或團體）對此項改變得支持預算Yueh-YenFangStep2:行動計畫考慮阻礙及組織對改變的準備度Yueh10Step2:行動計畫TheModelforImprovement(AssociatesinProcessImprovement,2007)SettingAimsFormingtheteamEstablishingMeasuresSelectingChangesTestingChangesP:PlanningitD:TryingitS:ObservingtheresultA:ActingonwhatislearnedImplementingChangesSpreadingChangesYueh-YenFangStep2:行動計畫TheModelforImpro11Step3:進行改變ConductingapilotofthechangeCommunicatethechangetorelatedindividualsandgroupsStaffmeetings,inservices,e-mail,bulletinboard,video,etc.AssigningresponsibilitiesAllocatingresourcesImplementthechangeYueh-YenFangStep3:進行改變Conductingapilot12Step4:評估成效改變帶來什麼衝擊？預期成效達到了嗎？TypeofmeasureProcessmeasuresOutcomemeasuresBalancingmeasuresMetricsdevelopment定義測量目的選擇評估區域選擇指標詳述測量設計評估指標Yueh-YenFangStep4:評估成效改變帶來什麼衝擊？Yueh-Yen13Step5:

向組織決策者報告初階成效組織決策者可以是一委員會或組織領導使用正式專案摘要格式進行報告描述、定義臨床問題描述當今實證描述改變建議Yueh-YenFangStep5:

向組織決策者報告初階成效組織決策者可以是一14Step6:贏得組織決策者對正式導入改變的支持建立組織支持的主要方法建立一完整的執行計畫估計人力、物力預算向組織決策者（組織領導、投資者）或委員會報告計畫Yueh-YenFangStep6:贏得組織決策者對正式導入改變的支持建立組織支持15Step7:指出下一步計畫將改變的範圍擴大（例：整個組織）調整行動計畫重新對相關的人或團體指派任務提供當事人教育訓練選擇評量方法Yueh-YenFangStep7:指出下一步計畫將改變的範圍擴大（例：整個組織16Step8:溝通成效InternalmembersExternalaudiencesJournalsConferencesProfessionalorganizationsYueh-YenFangStep8:溝通成效InternalmembersYue17CreatingaCultureofEvidence-BasedPracticeYueh-YenFangCreatingaCultureofEvidence18DevelopanEvidence-basedPracticeEnvironmentAsupportivecommittedleadershipThetopadministrationThechiefnurseexecutiveIdentificationandreductionofbarrierstoimplementationDevelopmentandmentoringofstaffYueh-YenFangDevelopanEvidence-basedPrac19TheEBPEnvironmentModel

(Hockenberry,Walden,Brown,&Barrera,2007)CreateaVisionforEBPEngagePersonnelandResourcesEvaluatetheEvidenceIntegrateEBPandNourishtheCulturePersistencePatiencePerseveranceTheEBPEnvironmentModel

(Hoc20KeyStrategiesEstablishthecultureDevelopthecapacitySustainthechangeYueh-YenFangKeyStrategiesEstablishthecu21EstablishtheCultureThedevelopmentofamissionSupportthespiritofinquiryandlifelonglearningnecessaryforEBPDemandandsupportnurses’accountabilityforpracticeanddecisionmakingMakeevidence-basedclinicalandadministrativedecisionmakingasastandingagendaYueh-YenFangEstablishtheCultureThedevel22EstablishtheCultureThedevelopmentofastrategicplanforestablishingEBPintoalllevelsoftheorganizationGoalsandobjectivestimeframesResponsibilitiesEvaluationprocessEstablishmentofresources(people,time,money,education,mentoring)Yueh-YenFangEstablishtheCultureThedevel23EstablishtheCultureCharacteristicsandRoleoftheCNEVisibleBeingachampionandleaderofEBPPresenttheleadership’svisionofEBPSupportiveinEBPactivitiesandenvironmentestablishmentPresentleadershipcommitmenttoEBPParticipateinEBPactivitiesincludingeducationandtrainingIdentifyandremovepotentialbarriersYueh-YenFangEstablishtheCultureCharacter24DeveloptheCapacityOrganizationalinfrastructuresupportsEBPHumanandmaterialresourcesEstablishmentofareadycultureYueh-YenFangDeveloptheCapacityOrganizati25DeveloptheCapacityAdoptanappropriateEBPmodelIdentifychangechampionsfromdifferentorganizationallevelsandspecialtiesRolemodelsofprofessionalpracticeAccountableCollaboratorsTeamplayersCompetencebuildingEnhancejobdescriptionAvailabilityofEBPtoolsYueh-YenFangDeveloptheCapacityAdoptana26SustaintheChangeDevelopownershipatalllevelstomakeEBPaspartoftheentireorganizationanddailyroutine.LinkEBPprojectstoorganizationalprioritiesandmission.Presentcost-effectivenessandsatisfactionofEBPCommunicatetothetargetaudiences(includingdevelopmentofanEBPwebsite)RewardtheEBPchampions,mentors,andstaffYueh-YenFangSustaintheChangeDevelopowne27TheEstablishmentofClearExpectationsYueh-YenFangTheEstablishmentofClearExp28IncorporatingEBPin

JobDescriptions

(JohnHopkinsHospital)

NurseClinicianIAppliesascientificbasis/EBPapproachtowardnursingpracticeComplywithchangesinclinicalpracticeandstandards.Participateindatacollection.Posesquestionswhenevidenceandpracticediffer.Consultexpertswhenthepracticeisquestioned.UseappropriateresourcestoanswerEBPquestions.Reviewcurrentevidencerelevanttopractice.Yueh-YenFangIncorporatingEBPin

JobDesc29IncorporatingEBPinJobDescriptions

(JohnHopkinsHospital)

NurseClinicianIIAppliesascientificbasis/EBPapproachtowardnursingpracticeSeekand/orarticulaterationaleandscientificbasisforclinicalpracticeorchangesinstandards.Supportresearch-basedclinicalpractice(teaches,rolemodels,practices)Participateindatacollection.Identifydifferencesinpracticeandbestevidence.Generateclinicalquestions,searchevidence,andreviewsevidencerelatedtoareaofpractice.ConsultexpertstoanswerEBPquestions.Articulateevidence-basedrationaleforcare.Yueh-YenFangIncorporatingEBPinJobDescr30IncorporatingEBPin

JobDescriptions

(JohnHopkinsHospital)

NurseClinicianIIIInterpretresearchandusescientificinquirytovalidateand/orchangeclinicalpracticeEvaluateresearchfindingswithpotentialimplicationsforchangingclinicalpractice,comparepracticetofindings,andtakeappropriateaction.Designtooland/orparticipateindatacollectionandotherspecificassignments(e.g.,literaturereview)intheconductofresearchMentorstafftoidentifydifferencesinpracticeandbestevidence,generateclinicalquestions,searchevidence,reviewandcritiqueevidencerelatedtoareaofclinical,administrative,oreducationpractice.Yueh-YenFangIncorporatingEBPin

JobDesc31NurseClinicianIIIServeasaresourceandmentorinevidence-baseddiscussionsarticulatingrationaleforpractice.ParticipateinimplementingEBPthroughrolemodelingandsupportofpracticechanges.IncorporatesEBPintodailypatientcareandleadershipresponsibilities.Participatesin/supportsEBPprojectswithinunit/