1、臨床導入臨床導入與與成效評估成效評估方月燕方月燕,Ph.D.,RN,Ph.D.,RN輔英科技大學護理系輔英科技大學護理系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 YuehYueh-Yen Fang-Yen Fang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,and finance)將EBP明確納入標準設置及工作職責中。YuehYueh-Yen Fang-Yen Fang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（Change Theory）激勵理論（Moti
2、vational theory）知悉政治（Political savvy）組織過程（Organizational process）權力運作（Dynamics of power）Yueh-Yen Fang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-Yen FangJHNEBP 臨床導入流程 Step 1:決策該實證建議導入特定單位的適當性及可行性 Step 2:建立行動計畫 Step 3:進行改變 Step 4:評估成效 Step 5
3、:向組織決策者報告初階成效 Step 6:贏得組織決策者對正式導入改變的支持 Step 7:指出下一步計畫 Step 8:溝通成效Yueh-Yen FangStep 1:適當性及可行性 Stetler(2001)實證標準 The findings consistency Quality Quantity 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-Yen FangStep 1: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Yue
4、h-Yen FangStep 2: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-Yen FangStep 2: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-Yen FangStep 2:行動計畫The Model for Improvement(Associates in Process Improvement,2007)Setting AimsForming the teamEstablishing MeasuresS
5、electing ChangesTesting ChangesP:Planning itD:Trying itS:Observing the resultA:Acting on what is learnedImplementing ChangesSpreading ChangesYueh-Yen FangStep 3:進行改變 Conducting a pilot of the change Communicate the change to related individuals and groups Staff meetings,inservices,e-mail,bulletin bo
6、ard,video,etc.Assigning responsibilities Allocating resources Implement the changeYueh-Yen FangStep 4:評估成效 改變帶來什麼衝擊？預期成效達到了嗎？Type of measure Process measures Outcome measures Balancing measures Metrics development 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-Yen FangStep 5: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
7、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-Yen FangStep 6: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-Yen FangStep 7: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-Yen FangStep 8:溝通成效 Internal members External audiences Journals Conferences Professional or
8、ganizationsYueh-Yen FangCreating a Culture of Evidence-Based PracticeYueh-Yen FangDevelop an Evidence-based Practice Environment A supportive committed leadership The top administration The chief nurse executive Identification and reduction of barriers to implementation Development and mentoring of
9、staffYueh-Yen FangThe EBP Environment Model(Hockenberry,Walden,Brown,&Barrera,2007)Create a Vision for EBPEngage Personnel and ResourcesEvaluate the EvidenceIntegrate EBP and Nourish the CulturePersistence Patience PerseveranceKey Strategies Establish the culture Develop the capacity Sustain the cha
10、ngeYueh-Yen FangEstablish the Culture The development of a mission Support the spirit of inquiry and lifelong learning necessary for EBP Demand and support nurses accountability for practice and decision making Make evidence-based clinical and administrative decision making as a standing agendaYueh-
11、Yen FangEstablish the Culture The development of a strategic plan for establishing EBP into all levels of the organization Goals and objectives time frames Responsibilities Evaluation process Establishment of resources(people,time,money,education,mentoring)Yueh-Yen FangEstablish the Culture Characte
12、ristics and Role of the CNE Visible Being a champion and leader of EBP Present the leaderships vision of EBP Supportive in EBP activities and environment establishment Present leadership commitment to EBP Participate in EBP activities including education and training Identify and remove potential ba
13、rriersYueh-Yen FangDevelop the Capacity Organizational infrastructure supports EBP Human and material resources Establishment of a ready cultureYueh-Yen FangDevelop the Capacity Adopt an appropriate EBP model Identify change champions from different organizational levels and specialties Role models
14、of professional practice Accountable Collaborators Team players Competence building Enhance job description Availability of EBP toolsYueh-Yen FangSustain the Change Develop ownership at all levels to make EBP as part of the entire organization and daily routine.Link EBP projects to organizational pr
15、iorities and mission.Present cost-effectiveness and satisfaction of EBP Communicate to the target audiences(including development of an EBP website)Reward the EBP champions,mentors,and staffYueh-Yen FangThe Establishment of Clear ExpectationsYueh-Yen FangIncorporating EBP in Job Descriptions(John Ho
16、pkins Hospital)Nurse Clinician I Applies a scientific basis/EBP approach toward nursing practice Comply with changes in clinical practice and standards.Participate in data collection.Poses questions when evidence and practice differ.Consult experts when the practice is questioned.Use appropriate res
17、ources to answer EBP questions.Review current evidence relevant to practice.Yueh-Yen FangIncorporating EBP in Job Descriptions(John Hopkins Hospital)Nurse Clinician II Applies a scientific basis/EBP approach toward nursing practice Seek and/or articulate rationale and scientific basis for clinical p
18、ractice or changes in standards.Support research-based clinical practice(teaches,role models,practices)Participate in data collection.Identify differences in practice and best evidence.Generate clinical questions,search evidence,and reviews evidence related to area of practice.Consult experts to ans
19、wer EBP questions.Articulate evidence-based rationale for care.Yueh-Yen FangIncorporating EBP in Job Descriptions(John Hopkins Hospital)Nurse Clinician III Interpret research and use scientific inquiry to validate and/or change clinical practice Evaluate research findings with potential implications
20、 for changing clinical practice,compare practice to findings,and take appropriate action.Design tool and/or participate in data collection and other specific assignments(e.g.,literature review)in the conduct of research Mentor staff to identify differences in practice and best evidence,generate clin
21、ical questions,search evidence,review and critique evidence related to area of clinical,administrative,or education practice.Yueh-Yen Fang Nurse Clinician III Serve as a resource and mentor in evidence-based discussions articulating rationale for practice.Participate in implementing EBP through role
22、 modeling and support of practice changes.Incorporates EBP into daily patient care and leadership responsibilities.Participates in/supports EBP projects within unit/departmemnt.Incorporating EBP in Job Descriptions(John Hopkins Hospital)Yueh-Yen FangMeasuring EBP Outcomes Quality management/indicato
23、rs Fall rates,UTI rates,pressure ulcer rates Financial data Cost effectiveness Human resource Turnover,staff edu.levels Clinical systems Lab tests,pharmacy data,nursing systems Administration LOS Electronic health records Survey or clinical observationsHow well the EBP is implemented?Awareness of current evidence Acceptance of current evidence Keeping up to date with new knowledge Capability of updating practice content and acceptance of the change Extensiveness of EBP used across professions and units EBP outcomes are evaluated.Yueh-Yen FangThank You.Yueh-Yen Fang
