臨床導(dǎo)入與成效評(píng)價(jià)方月燕PhDRN輔英科技大學(xué)護(hù)理系課件

臨床導(dǎo)入

與

成效評(píng)估方月燕,Ph.D.,RN輔英科技大學(xué)護(hù)理系臨床導(dǎo)入

與

成效評(píng)估方月燕,Ph.D.,RN1影響臨床導(dǎo)入的因素組織支持人力、物力資源員工對(duì)組織的承諾跨團(tuán)隊(duì)組織的功能Yueh-YenFang影響臨床導(dǎo)入的因素組織支持Yueh-YenFang2成功導(dǎo)入要件具備相信EBP能使病人照護(hù)成效最佳化之文化每一行政層級(jí)均具備有力領(lǐng)導(dǎo)協(xié)助各項(xiàng)資源提供(human,technology,andfinance)將EBP明確納入標(biāo)準(zhǔn)設(shè)置及工作職責(zé)中。Yueh-YenFang成功導(dǎo)入要件具備相信EBP能使病人照護(hù)成效最佳化之文化Yue3執(zhí)行臨床導(dǎo)入的知識(shí)與技能領(lǐng)導(dǎo)者須具備的知識(shí)與技能改變理論（ChangeTheory）激勵(lì)理論（Motivationaltheory）知悉政治（Politicalsavvy）組織過(guò)程（Organizationalprocess）權(quán)力運(yùn)作（Dynamicsofpower）Yueh-YenFang執(zhí)行臨床導(dǎo)入的知識(shí)與技能領(lǐng)導(dǎo)者須具備的知識(shí)與技能Yueh-Y4執(zhí)行臨床導(dǎo)入的知識(shí)與技能個(gè)人能安全、適當(dāng)、有效使用實(shí)證所需的知識(shí)與技能基本研究知識(shí)運(yùn)用研究結(jié)果及實(shí)證照護(hù)的知識(shí)與技能推論性統(tǒng)計(jì)的知識(shí)與解讀能力，和將研究結(jié)果運(yùn)用於個(gè)人層面。探究範(fàn)圍的專(zhuān)業(yè)知識(shí)Yueh-YenFang執(zhí)行臨床導(dǎo)入的知識(shí)與技能個(gè)人能安全、適當(dāng)、有效使用實(shí)證所需的5JHNEBP臨床導(dǎo)入流程Step1:決策該實(shí)證建議導(dǎo)入特定單位的適當(dāng)性及可行性Step2:建立行動(dòng)計(jì)畫(huà)Step3:進(jìn)行改變Step4:評(píng)估成效Step5:向組織決策者報(bào)告初階成效Step6:贏得組織決策者對(duì)正式導(dǎo)入改變的支持Step7:指出下一步計(jì)畫(huà)Step8:溝通成效Yueh-YenFangJHNEBP臨床導(dǎo)入流程Step1:決策該實(shí)證建議導(dǎo)入6Step1:適當(dāng)性及可行性Stetler(2001)實(shí)證標(biāo)準(zhǔn)Thefinding’sconsistencyQualityQuantity單位適合性組織內(nèi)容與結(jié)構(gòu)

（設(shè)備資源、改變能力、組織準(zhǔn)備度、需求狀況、護(hù)理過(guò)程、政策、人員能力）可行性實(shí)證是否能有效改善問(wèn)題目前的臨床操作Yueh-YenFangStep1:適當(dāng)性及可行性Stetler(2001)Y7Step1:適當(dāng)性及可行性需思考的問(wèn)題…這項(xiàng)改變是否可改善臨床或管理成效？增進(jìn)內(nèi)、外部顧客滿意度降低照護(hù)或管理支出Yueh-YenFangStep1:適當(dāng)性及可行性需思考的問(wèn)題…Yueh-Yen8Step2:行動(dòng)計(jì)畫(huà)行動(dòng)計(jì)畫(huà)內(nèi)容實(shí)施及評(píng)值的計(jì)畫(huà)書(shū)、指引、臨床路徑或系統(tǒng)/流程時(shí)程表組織領(lǐng)導(dǎo)者、臨床專(zhuān)業(yè)人員及機(jī)構(gòu)投資者對(duì)計(jì)畫(huà)書(shū)的看法Yueh-YenFangStep2:行動(dòng)計(jì)畫(huà)行動(dòng)計(jì)畫(huà)內(nèi)容Yueh-YenFang9Step2:行動(dòng)計(jì)畫(huà)考慮阻礙及組織對(duì)改變的準(zhǔn)備度足夠的人力、物力資源目前的工作流程組織決策者（個(gè)人或團(tuán)體）對(duì)此項(xiàng)改變得支持預(yù)算Yueh-YenFangStep2:行動(dòng)計(jì)畫(huà)考慮阻礙及組織對(duì)改變的準(zhǔn)備度Yueh10Step2:行動(dòng)計(jì)畫(huà)TheModelforImprovement(AssociatesinProcessImprovement,2007)SettingAimsFormingtheteamEstablishingMeasuresSelectingChangesTestingChangesP:PlanningitD:TryingitS:ObservingtheresultA:ActingonwhatislearnedImplementingChangesSpreadingChangesYueh-YenFangStep2:行動(dòng)計(jì)畫(huà)TheModelforImpro11Step3:進(jìn)行改變ConductingapilotofthechangeCommunicatethechangetorelatedindividualsandgroupsStaffmeetings,inservices,e-mail,bulletinboard,video,etc.AssigningresponsibilitiesAllocatingresourcesImplementthechangeYueh-YenFangStep3:進(jìn)行改變Conductingapilot12Step4:評(píng)估成效改變帶來(lái)什麼衝擊？預(yù)期成效達(dá)到了嗎？TypeofmeasureProcessmeasuresOutcomemeasuresBalancingmeasuresMetricsdevelopment定義測(cè)量目的選擇評(píng)估區(qū)域選擇指標(biāo)詳述測(cè)量設(shè)計(jì)評(píng)估指標(biāo)Yueh-YenFangStep4:評(píng)估成效改變帶來(lái)什麼衝擊？Yueh-Yen13Step5:

向組織決策者報(bào)告初階成效組織決策者可以是一委員會(huì)或組織領(lǐng)導(dǎo)使用正式專(zhuān)案摘要格式進(jìn)行報(bào)告描述、定義臨床問(wèn)題描述當(dāng)今實(shí)證描述改變建議Yueh-YenFangStep5:

向組織決策者報(bào)告初階成效組織決策者可以是一14Step6:贏得組織決策者對(duì)正式導(dǎo)入改變的支持建立組織支持的主要方法建立一完整的執(zhí)行計(jì)畫(huà)估計(jì)人力、物力預(yù)算向組織決策者（組織領(lǐng)導(dǎo)、投資者）或委員會(huì)報(bào)告計(jì)畫(huà)Yueh-YenFangStep6:贏得組織決策者對(duì)正式導(dǎo)入改變的支持建立組織支持15Step7:指出下一步計(jì)畫(huà)將改變的範(fàn)圍擴(kuò)大（例：整個(gè)組織）調(diào)整行動(dòng)計(jì)畫(huà)重新對(duì)相關(guān)的人或團(tuán)體指派任務(wù)提供當(dāng)事人教育訓(xùn)練選擇評(píng)量方法Yueh-YenFangStep7:指出下一步計(jì)畫(huà)將改變的範(fàn)圍擴(kuò)大（例：整個(gè)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/