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When proposing a change, it is guaranteed there will be barriers that interfere with not only the implementation, but the continuation and longevity of that change. Two barriers I expect to face when implementing delayed bathing include:
Variations in the timing of the bath- as the time gap gets larger and larger from the implementation of the project, nurses may slowly begin to give the bath earlier and earlier, depending on what fits their needs best. Even if the bath is still delayed, it may affect future research if it is supposed to be based off of a 24 hour delay. One way to prevent this is to create a policy that states the newborn must be at least 24 hours old before receiving a bath. There are other tasks that the nurse must complete at 24 hours of age (The state newborn screen, the CCHD screen, transcutaneous bili, and reweigh the newborn). The bath could just be implemented during this time.
Inconsistent retrieval of vital signs and breast feeding times-Along with the slow creep of an earlier bath, a second potential barrier could be inconsistent retrieval of infant vital signs, as well as breast feeding times and success rates. (different timing due to patient load, priority of care, difference in nurse preference). If the retrieval times are varied, the accuracy of any research could be flawed. It is important that both items are collected at the same intervals (1,4, 8,12,16, and 24 hours of age) and charted in real time for accuracy. If the results aren’t accurate, we will not be able to properly assess whether delaying bathing is making a difference among our patients and promoting their health.
When looking at these barriers and the threat that they could pose to the continuity of the proposed change, it is important to trouble shoot and find ways to address these barriers. One of the first steps is educating the nurses who will be implementing the change. “Nursing leaders must play a key role in envisioning and enabling a new way forward” (Wheatley et al., 2017). Properly educating them on why the change is being implemented and training them how to educate parents on the change. A final way to address the barriers that may prevent the change from being sustainable is creating a clear vision for change and transformation. “Without that clarity of vision in the day-to-day implementation and operation, it is doubtful that the model can spread successfully” (Wheatley et al., 2017).
Wheatley, L., Doyle, W., Evans, C., Gosse, C., & Smith, K. (2017). Integrated Comprehensive Care — A Case Study in Nursing Leadership and System Transformation. Nursing Leadership (1910-622X), 30(1), 33–42. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=ccm&AN=123799994&site=ehost-live&scope=site
One potential barrier that could influence my EBP change is clinical practice in healthcare workers. My propose change is to increase breastfeeding rates. To break the barriers one way is to assess the current clinical practice in my organization by observing the individual behaviors and interaction (NHS, 2018). Direct observation will help address any issues and find prompt solutions. I believe this is proper intervention to observe what is happening most often, breastfeeding. Continue education for healthcare professionals and patients could assure the project change will remain active for at least 6 months to a year. The worldview and attitudes towards breastfeeding could be another challenge. These could be overcome with further support and knowledge. Another potential barrier is change. Change established behavior of any kind is difficult (NHS, 2018). Change takes time; change may bring fear or uncertainties and some individual may be reluctant to change. Having an organization with strong leadership and an engaged staff on improving patient care would likely develop a motivated staff with the need for continuous improvement. The more engaged the staff is in the project the easier it will be to adapt the new practice. Supporting the staff in the process is important to minimized overwhelming them with new practices or skills and lessens fears of change. Inconsistency and noncompliance may also be encounter when initiating a change, but I will have a clear structure in place to support my implementation of evidence-based practice change guidance.
NHS. (2018). How to change practice. Retrieved from https://nice.org.uk
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