Introduction
It is important to note that the nursing process is a critical thinking model which needs to adhere to a specific list of competencies. One of such competencies includes cultural diversity and inclusion since healthcare is a universal need. However, one should acknowledge that there are differences between cultures, which is why nursing professionals must be competent in providing care with this form of consideration. The emphasis for the project on central line-associated bloodstream infections or CLABSI project needs to focus on the safety culture or culture of clinical excellence, which is determined by organizational culture.
Cultural Considerations of the Evidence-Based Practice Project’s Stakeholders
A unique cultural characteristic of the EBP target audience is the safety culture among full-time nurses. One should be aware that such a culture of clinical excellence is a part of organizational culture, which can be attributable to the nursing staff. It is stated that “safety culture is the product of individual and group values, attitudes, perceptions, competencies and behavior patterns that determine the commitment, style, and proficiency of managing a healthy and safe organization” (Costa et al., 2018, p. 2). In other words, it is a complex system of beliefs and practices that create an environment of safety for patients.
Moreover, a poor safety culture can manifest itself without a deliberate effort to do so because it can be a byproduct of focus on efficiency or work volume. It should be noted that “a culture that accepts and adopts extra roles as a normal daily routine may not articulate or perceive any impact of such additional work” (Ross et al., 2018, p. 3). Thus, it is clear that many elements of safety culture are not directly or visibly perceivable by those who practice it. For example, a nurse might take on an additional workload in order to help more patients and assist his or her colleagues, but the result is a lowered safety culture. It is up to the management to ensure that a safety culture is established by implementing strict measures to prevent it or fully informing the nurses about the potential ramifications of excessive workload.
Graduate Level Competency 15 And Effective Communication Skills
The selected competency for the graduate-level prepared registered nurse from the ANA Standard 8, Culturally Congruent Practice, is competency number 15. It states that such a nurse “advances organizational policies, programs, services, and practices that reflect respect, equity, and values for diversity and inclusion” (Marion et al., 2017, para. 20). Any form of organizational change or shift in how healthcare is delivered can be faced with a multitude of challenges. One of the such issue might be organizational culture, which is resistant to the proposed or implemented changes. Therefore, effective communication can be a potent solution to ensure that nurses will be willing to adopt and integrate the policies or programs into their practice.
When it comes to effective communication, the latter is critical and vital not to dictate the new rules but rather to build trust and mutual respect. A study found that “hierarchical position has no significant effect on the reduction of resistance to process improvement changes … only trust in management has a significant effect on employees’ attitudes” (Pereira et al., 2019, p. 1564). In other words, trust in those who seek to implement new changes, such as the enhancement of a safety culture, is essential. Thus, competency 15 of the ANA Standard 8 on Culturally Congruent Practice only will benefit from effective communication but necessitates its use. The EBP project itself focuses on establishing a culture of clinical excellence for communication between leaders and nurses, thus ensuring they participate in all discussions. The given objective is unachievable without effective communication. The proposed solutions and changes must be communicated with clarity and comprehensiveness when it comes to their message, intent, purpose, and reason behind them.
Applying Two of The ANA Competency Standards’ Goals to The EBP Project
The project’s goal is to ensure that 100% of full-time nurses working with hospitalized patients with central lines complete education sessions on preventing CLABSI in three months. Therefore, the competency goal is to advance “organizational policies, programs, services, and practices that reflect respect, equity, and values for diversity and inclusion” (Marion et al., 2017, para. 20). Since the purpose of the EBP project is to make the nursing practice safer to prevent CLABSI within a three-month period, many of the objectives are centered around organizational culture and policy changes. The first objective is to ensure there are brief regular meetings for leaders and nurses to discuss the current problems and existing concerns to find a solution. The second one is to guarantee the patient outcome is improved within three months since the prevalence of infections would be decreased. The most important objective is to establish a culture of clinical excellence for communication between leaders and nurses, thus ensuring they participate in all discussions.
The next phase of the plan is about professional leaders managing 100% of full-time nurses and demonstrating compliance in all nursing activities that affect the quality of care given to patients with central lines within a three-month period. The key objective is to ensure a standard guideline with activities for all nurses who work in particular units after thoroughly examining the achievements and findings. In addition, it is important to make sure nurses have a clear plan of how to organize their activities. In the case of the competency goal, it follows the same framework as the core objectives as a plan. In other words, nurses in the organization will not be forced or dictated to act in a specific manner. In order to “reflect respect, equity, and values for diversity and inclusion,” it is critical to build and maintain mutual respect and trust between nursing managers and nursing professionals (Marion et al., 2017, para. 20). The competency plan is comprised of five major steps or components, which are rooted in the evidence provided above.
The plan’s first step is to communicate the problem at hand as clearly and succinctly as possible. The second step is to explain the plan and strategy to resolve the CLABSI problem, which is a novel organizational culture, policy, and practice change. The third stage is to provide evidence behind the proposed changes in order to ensure that the culturally congruent practice is the application of EBP. The fourth phase of the competency plan revolves around acknowledging and addressing the resistance points expressed by nurses, and it is expected that the nursing staff will complain about some aspects of the proposed changes. The final step is about securing mutual trust between the managers and nurses prior to the implementation, where all key problematic points are addressed and resolved.
The evidence-based central line insertion and maintenance protocols alone may not prevent infections. The latter calls for a multifaceted methodology that necessitates behavior change for nurses that can be achieved through teamwork, assessment of performance, improving safety culture, and creating awareness. It is suggested that a multifaceted methodology can be used to control and reduce device-associated ICU-acquired infections (Alp & Rello, 2019). However, a bundle intervention effectively implements change and improves the “culture” of patient safety by promoting teamwork, measuring compliance, and providing feedback (Wasserman & Messina, 2018). In other words, a safety culture ensures that catheters are inserted utilizing aseptic techniques.
Conclusion
In conclusion, the nursing process is a multifaceted practice that mandates adherence to a list of competencies. Cultural element is among these factors, which determines the ANA Standard 8 on Culturally Congruent Practice. The prime focus of the given analysis is competency 15 because it is the most relevant and critical one for the EBP project to prevent CLABSI by establishing a culture of clinical excellence or better safety culture. It is important that the formation of communicative competence is reflexive. To do this, in the first stage of training, the manager must draw up a personal map of communicative competence. The manager must set a goal with clarity on the concept of communicative competence in relation to the project and identify indicators for achieving it. It is necessary to track these indicators not only during the study of the effectiveness of the change but also throughout the entire period of the cultural shift.
References
Alp, E., & Rello, J. (2019). Implementation of infection control bundles in intensive care units: Which parameters are applicable in low-to-middle income countries?Journal of Hospital Infection, 101(3), 245-247.
Costa, D. B. da, Ramos, D., Gabriel, C. S., & Bernardes, A. (2018). Patient safety culture: Evaluation by nursing professionals.Text & Context Nursing, 27(3), 1-9.
Marion, L., Douglas, M., Lavin, M. A., Barr, N., Gazaway, S., Thomas, E., & Bickford, C. (2017). Implementing the new ANA standard 8: Culturally congruent practice.The Online Journal of Issues in Nursing, 22(1), 1.
Pereira, V. R., Maximiano, A. C. A., & Bido, D. de S. (2019). Resistance to change in BPM implementation.Business Process Management Journal, 25(7), 1564-1586.
Ross, C., Rogers, C., & King, C. (2018). Safety culture and an invisible nursing workload. Collegian. 26(1), 1-7.
Wasserman, S., & Messina, A. (2018). Bundles in infection prevention and safety [PDF document].