NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Healthcare organizations and leaders are under pressure to improve outcomes by creating a structure/culture/environment in which exploration of critical inquiry and the available body of evidence is an integral part of daily nursing practice. To achieve Magnet^(R) accreditation, for example, an organization must demonstrate that nurses are innovators and contribute to quality patient outcomes through EBP. The evolution of pay-for-performance and heightened focus on quality outcomes for regulatory bodies and payers continues to sustain the drive for EBP.

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Overcoming barriers to EBP

Major barriers for nurses in adopting the EBP process as part of their daily practice are the high demands of providing patient care and limits on available time, resources, and structures. In addition, nurses within an organization may not yet have successfully demonstrated how having time and resources for EBP can support them in contributing in a meaningful way through improved patient outcomes and cost savings. Learning how to better link dollars to outcomes to portray a return on investment that demonstrates how EBP contributes to an organization’s profit margin could possibly justify additional investment in time and resources.

Administrators and educators continue to strive to encourage all nurses to perceive EBP as a consistent approach to providing patient care rather than an “extra” duty or project. However, the step of naturally including research evidence in decision making, instead of relying only on what nurses already know or have seen others doing, remains a complex issue in current nursing practice. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

One strategy to re frame nurses’ understanding of the types of information used for clinical decision making is to categorize information garnered from empirical, ethical, personal, and aesthetic sources of professional nursing practice.4

* Empirical evidence is information acquired by observation or experimentation. It evolves from scientific research and comprises the science of nursing component of professional nursing practice.4 Data are recorded and analyzed by researchers who make practice recommendations and/or recommendations for conducting additional studies. Empirical evidence is found in published documents that provide background information, methods used to conduct the study, study findings, and a discussion of how the results may be used in practice. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

* Ethical evidence, based on nurses’ knowledge of, and respect for, patients’ unique values and preferences, is practiced as the ethics of nursing.4 Nurses have the ability to influence patient-care outcomes by using their nursing knowledge and skills, their individual understanding of ethical principles, the nurse-patient and nurse-healthcare team relationships they establish, and good communication skills. An understanding of ethical principles, such as autonomy, beneficence, and justice, is used by nurses in all aspects of caring; respect and honesty established within the nurse-patient relationship positively influence the actions and behaviors of others.5

* Personal evidence evolves from nurses’ individual experiences while caring for particular patients and is based on the interpersonal relationships of nursing.4 Whether nurse-patient relationships last a few hours or continue long-term, they’re used to support a patient, promote healing, and preserve or enhance function. Therapeutic relationships are health-focused, patient-centered, and have boundaries that distinguish them from social relationships. Nurses must be able to respect another person’s beliefs and be nonjudgmental even when a patient’s beliefs differ from their own world views.

* Aesthetic evidence is based on the nurse’s intuition, interpretation, understanding, and values; considered the art and practice of nursing.4 Aesthetic knowing addresses the nurse’s perception of significant elements of a patient’s behavior and life circumstances. The nurse can use this information to individualize the care plan so that proposed interventions can be successful.

Empirical, ethical, personal, and aesthetic ways of acquiring, processing, reflecting, and evaluating nursing knowledge are important for helping nurses form a comprehensive clinical perspective that can be used to accomplish best-possible outcomes.7 Nurses can be mentored to balance their personal professional practice scale by incorporating the four types of nursing evidence when gathering information for clinical decision making.

NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Integrating evidence into practice

Re framing EBP using components that define how professional nurses practice aligns with the description of EBP as an integration of clinical expertise with the best available external clinical research evidence and patients’ unique values and circumstances. This approach is congruent with the definition by Sackett et al. of EBP as the conscientious, explicit, and judicious use of current best evidence in making clinical practice and policy decisions.8 Sackett et al. defined steps for the EBP process (ask, gather, appraise, act, and evaluate) to guide healthcare providers to clarify the clinical topic of interest (ask), gather and appraise evidence, incorporate best practice recommendations in current practice (act), and evaluate outcomes.

Melnyk and colleagues, as leaders of nursing EBP, have advocated that a culture of clinical inquiry is essential to actualize EBP in nursing.9 They recommended adding Step 0 to Sackett’s original five steps to highlight that an organization must create an environment where nurses have authority to openly question current practice. These authors also added a sixth step: Dissemination of the EBP process to support the need for professional nurses to contribute to the body of evidence that guides nursing practice.10 NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Disseminating EBP through clinical inquiry

Clinical inquiry has been defined as the ongoing process of questioning and evaluating practice and advancing informed practice.11 Clinical inquiry should raise questions about the practice of an individual or a group of nurses in a practice setting and can lead to creating (innovating) and implementing practice changes through research utilization and experiential learning.

Clinical inquiry can be thought of as the nurse’s inner voice that consistently questions: “Am I offering everything that’s currently available to achieve the best outcome?” or “What else can be done?” when best outcomes aren’t being achieved with current practice. Clinical inquiry should be sparked whenever nurses express rationales for their practice such as, “It’s the way we do things here,” “We’ve always done it that way,” “It’s how I was shown,” “It’s what I saw everyone doing,” or “It’s how the physician/nurse prefers to do it.” To be evidence-based, care discussions and decision making need to center on evidence in relation to outcomes, not merely traditional practices and current knowledge. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Clinical inquiry can be addressed by three different methodologies: EBP, research, and quality improvement (QI). Clinical inquiry should be first addressed by the EBP process to develop the clinical question and gather and appraise evidence. (See Methodologies for clinical inquiry.) As discussed below, research or QI methodologies may be used in Step 4 (act) of the EBP process when implementing or testing new strategies or interventions that were identified during Steps 1 to 3 of the EBP process.

Acknowledging that nurses often more easily understand and incorporate ethical, personal, and aesthetic information in practice can support a focus for determining how to more naturally include empirical evidence in everyday practice. By assimilating clinical inquiry and use of the EBP process steps as a natural way of practicing nursing, nurses can begin to actualize EBP.

Six steps to EBP

Clinical inquiry leads naturally to the five steps of the EBP process defined by Sackett et al.-ask, gather, appraise, act, and evaluate-plus a sixth step, disseminate, suggested by Melnyk et al. Learning these EBP process steps can support nurses’ ability to describe EBP just as other acronyms, mnemonics, and prompts are used to describe other practices. For example, when asked how to operate a fire extinguisher, nurses can recall the acronym PASS and describe how they pull, aim, squeeze, and sweep to extinguish a fire. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Similarly, by remembering the six steps of the EBP process, nurses can describe how they address clinical problems or situations. For example, when a problem is identified, application of clinical inquiry naturally leads to development of a clinical question as Step 1 of the EBP process: ask. Keywords and the question topic are used to gather evidence from scientific sources as Step 2. In Step 3, all retrieved evidence is appraised and best practice recommendations or interventions are identified. This information is used for Step 4: act by comparing current practice to what was identified in empirical evidence and offering the best practice recommendations and strategies in the nursing care provided. Step 5, evaluate, is carried out to determine if the best patient outcomes are being achieved. In Step 6, disseminate, the findings are shared with nursing colleagues to advance nursing practice. Dissemination planning should be included in the initial project or study planning phase. NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Step 1: Ask. Stillwell et al. have advocated the importance of asking the “right” question.15,16 As problems emerge from clinical situations in which there is uncertainty or a knowledge gap regarding how best to respond, they can be formatted as questions and can be addressed from a variety of angles, such as:

* diagnosis. What information do healthcare providers need to know when providing care for patients diagnosed with an illness?

* therapy. Which nursing intervention is most effective, or what is an effective treatment given a particular health disorder?

* harm/etiology. Is a particular intervention likely to have harmful effects, or how can harmful effects be avoided?

* prognosis. What is the patient’s likely course of disease, or how to screen for an illness or reduce risk?

* prevention. How can patients’ risk factors be adjusted to help reduce the risk of disease?

* experience. What are the experiences or values of patients, caregivers, or nurses?

* education. What are the best teaching strategies for colleagues, patients, or family members?8

NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

STRATEGIES OF INTEGRATION OF EVIDENCE-BASED PRACTICE IN THE CLINICAL SETTINGS

Best Practices for Implementing Evidence-Based Guidelines

Hospital leaders agree: Evidence-based care protocols to guide how care is delivered are becoming the new norm. Putting guidelines in place can improve patient safety, streamline methods of care, lower costs and increase efficiency. Guidelines are especially useful for refining methods of care for high-volume, high-cost or high-risk conditions. The process for guideline implementation, however, can seem daunting, especially when it requires a large number of physicians from various specialties to agree to a single set of guidelines. However, the payoff can be better care and reduced variation — two major goals for healthcare providers. Here are nine best practices for working with evidence-based guidelines at all stages of the process.

1. Let physicians lead the charge. Successful guidelines start with those who provide care, and the most successful programs for implementing evidence-based quality measures rely heavily on clinician participation. Barton Hill, MD, vice president and chief quality officer at St. Luke’s Health System in Boise, Idaho, can attest to the importance of the individual clinician in evidence-based medicine. He believes that St. Luke’s success with implementing evidence-based guidelines is in large part due to clinicians with a vision of a hospital that practices in the best way it can. “It begins with one person having a passion and making a change,” he says.

Oscar Marroquin, MD, director of provider analytics and a cardiologist at University of Pittsburgh Medical Center, agrees. “Physicians are the ones who are going to decide whether we are utilizing our resources in the right way. They have to be at the table, because in our experience, if guidelines are physician-led and guideline content is developed by physicians, we’re more likely to succeed.”NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

2. Start small. Adopting evidence-based medicine doesn’t have to be an insurmountable undertaking. Dr. Hill’s best advice for hospitals looking to start evidence-based quality programs is to start small: Pick one or a few guidelines to investigate and implement, pilot the program results and clearly demonstrate program benefits. Choosing low-hanging fruit right out of the gate is a fine way to start, as it piques interest in evidence-based medicine and demonstrates the value of evidence-based quality guidelines, he says. If the going gets tough, Dr. Hill recommends keeping the ultimate goal of patient safety in mind. “What we want for ourselves and our family — that’s the litmus test,” says Dr. Hill. “You live in that community, and we all will be patients at some point.”NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

3. Embrace transparency. “Transparency during the guideline creation process is very important. We help everyone understand reasons behind a guideline so they can discuss it and have access to it after it’s completed,” says Val Slayton, MD, vice president of El Segundo, Calif.-based The Camden Group, a healthcare consulting firm. Ensuring clinicians understand the actual evidence that supports guidelines is also a must. “Providing a rating system for guidelines can help clinicians understand how strong the evidence is,” suggests Dr. Slayton.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

“We disseminate the guidelines among our clinicians for comment, inviting them to participate in the creation even if they are not a member of the team that created or designed them. If they want a change made, we ask them to support it with evidence from medical literature,” says Helen Macfie, PharmD, senior vice president of performance improvement at California-based MemorialCare Health System.

Dr. Hill agrees sharing progress with physicians is important. “One of the keys to success is being transparent. Sharing makes others intrigued and excited and makes people think that progress is worth the discomfort of change,” he says.

4. Communicate, communicate and communicate some more. When it comes to evidence-based guidelines, it’s impossible to communicate too much. “Sharing results and best practices with our associates creates a smooth process for implementation,” says Leslie Simmons, RN, FACHE, president of Westminster, Md.-based Carroll Hospital Center. “For instance, connecting the dots for physicians and staff and showing how following guidelines improve results is vital.” According to Mrs. Simmons, Carroll Hospital Center’s persistent communication with its staff has been instrumental in eliminating ventilator-related pneumonia for the last four years and central line infections in critical care units the last three years.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

It’s not always easy, however. “Awareness and communication are always a challenge,” says Patricia Davis-Hagens, RN, chief nursing officer and vice president of nursing and site administrator at Mercy Health’s Fairfield (Ohio) Hospital.  She recommends trying different modes of communication to attract different demographics of healthcare providers. “Younger employees gravitate towards our electronic bulletin boards, though paper boards seem to work with our more tenured employees,” she says. Finding alternate ways to present communication can also be useful. Fairfield Hospital had particular success in reducing patient falls when it personalized fall data to the patient population and publicly displayed information pertaining to the quality goal at hand, including the number of days since the last fall had occurred.

Tim Hannon, MD, MBA, an anesthesiologist and the founder of Indianapolis-based Strategic Healthcare Group, a company devoted to improving blood management, agrees: “It is possible to accelerate the guideline process by being smart, targeting appropriately, communicating, then over-communicating.”NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

5. Add a ‘why’ to every ‘what.’ Healthcare providers are smart and motivated and will almost certainly have questions about the necessity of a change. If a compelling rationale is readily available, the guideline process becomes a productive open dialogue. Not every clinician will respond similarly, however. In Dr. Hannon’s experience both as an internal physician champion and as an outside consultant, between 15 and 20 percent of physicians will either strongly support or strongly reject a guideline. The other 65 percent are the ideal target population for education. “Allow supporters to be vocal, educate those who are on the fence, and initially resistant clinicians may begin to participate in the change,” he says, noting that this bandwagon approach seems particularly effective.

6. Experiment with customization for best results. Just because a guideline exists does not mean it is right for every scenario. Identifying guidelines with potential caveats and working out a strategy to remind clinicians of possible variations is crucial. “There are times when guidelines should not be followed, given the unique patient’s condition. We work to identify those up front and build them right into our online guidelines to make it easy for the clinician to document those exceptions,” says Dr. Macfie of Memorial Care.

Another place where customization is crucial is in presenting guidelines: Each hospital must discover which type of presentation works with its staff. Ms. Davis-Hagens shared a particularly compelling example of a successful quality customization. Fairfield Hospital had a guideline for VTE prophylaxis in place, but quality administrators consistently documented less than 50 percent compliance. Physicians were simply forgetting to follow a well-accepted guideline.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

“Now that guideline is integrated to our electronic health record system. When we first made a hard stop in the physician order with the guideline, we got to 100 percent compliance within three weeks,” Ms. Davis-Hagens says.

7. Consider cost. True evidence-based care does not measure cost at all,” notes Dr. Hill. Having infinite resources for providing the best possible care would be ideal, but it is unfortunately never the case. As hospitals increasingly move to value-based payments, physicians will need to examine if a generic drug or lower cost supply can provide similar outcomes at a lower cost. “Ultimately, there will be some trade-offs between better population health outcomes, better care outcomes and lower costs,” Dr. Hill says. The trick is deciding how these trade-offs apply for every guideline according to an individual center’s institutional goals. Happily for all, it is not unusual for better, more efficient care to go hand-in-hand with lower costs.

8. Ensure guidelines are updated regularly. Even if it’s a job well done, the work isn’t over once a guideline is in place. “Guidelines must be revisited maybe every year or two to make sure evidence has kept up. You have to keep your guidelines current,” says Dr. Slayton of The Camden Group. To maintain and advance quality gains from evidence-based guidelines, hospitals must institute a system for consistent guideline review. Many healthcare centers do this with multiple committees of stakeholders responsible for the upkeep of one or a few guidelines.

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9. Show institutional support from leadership. Make commitment to evidence-based guidelines part of the institutional DNA. The bottom line is that evidence-based guidelines eliminate variations in care and give patients the best results scientific evidence can provide. The process is an incredibly collaborative one, and as such it requires robust support from administrators so it can take root, grow and flourish. Among other things, it requires effective administrative mediators and explicit support for clinicians and staff in quality-improvement endeavors.  It’s no secret, Dr. Marroquin of UPMC says, that getting consensus from groups of different physicians can sometimes be astonishingly difficult. The administrator’s role is to embrace the opportunity to sit in the middle and facilitate the process of reaching an agreement. “Leadership at highest level must say ‘this is important, we are going to do this, and we are going to transform ourselves,'” he says.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Institutional support goes beyond mediation, however. Hospitals and hospital systems should strive to establish long-term goals guiding quality improvements. Among hospitals represented here, MemorialCare Health System has instituted safety goals informing the system’s patient-centered philosophy on treating conditions with high rates of mortality, frequency or complication. St. Luke’s has made a quality-minded triple commitment to be physician-led, have an infrastructure of physician leaders and practice evidence-based medicine where it exists. Carroll Hospital Center not only supports quality improvement within its own institution, but also makes an effort to participate in every Maryland statewide collaborative contributing to research supporting guidelines and best practices in guideline implementation.

NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Implementing evidence-based practice – NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

What is it?

Evidence–based practice (EBP) is an approach to care that integrates the best available research evidence with clinical expertise and patient values.¹

It involves translating evidence into practice, also known as knowledge translation, and ensuring that ‘stakeholders (health practitioners, patients, family and carers) are aware of and use research evidence to inform their health and healthcare decision-making’.²

Why is it important?

Implementing clinical knowledge, and introducing new interventions and therapies, is an important way to minimize functional decline in older people.

• Four in 10 adult patients receive care that is not based on current evidence or guidelines, including ineffective, unnecessary or potentially harmful treatments.²
• Despite the availability of evidence-based guidelines, there are significant gaps in implementing evidence into routine clinical practice.³
• Translating evidence into practice can not only improve outcomes and quality of life for older people, it can also improve productivity and reduce healthcare costs.¹

How can you implement evidence-based initiatives to improve outcomes for older people?

Implementing evidence-based practice is a key part of improving outcomes for older people in hospital. When considering current best practice in the areas of nutrition, cognition, continence, medication, skin integrity, and mobility and self-care, a good first reference is the Older people in hospital website.

The National Safety and Quality Health Service Standards outlines the standards for providing best evidence care for older people in hospital.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

The ‘how to’ guide: turning knowledge into practice in the care of older people identifies a five-stage process to implementing change, which can be applied to translate evidence into practice.

Identify a practice that could be improved

• Select an area of interest in your clinical practice that could be improved – for example falls, medication errors or malnutrition.
• Identify current best practice guidelines and evidence-based interventions associated with improved outcomes.
• With your team, select an appropriate intervention and outcome measures that will influence your practice.
• Collaborate with quality teams and researchers with expertise in the area you are focusing on.

Barriers, enablers and issues

• Identify the barriers to implementing change. This includes anything that might obstruct or slow down the adoption of a new clinical intervention, such as feasibility, existing care processes or existing team culture.
• Explore the enablers to implementing change. This includes anything that might assist or encourage take up of a new evidence-based practice, such as positive staff attitudes, funding or alignment with accreditation standards.
• Consider issues for any data collection for measuring the effectiveness of your intervention.
• Plan for sustainability to ensure the change can be maintained.

The intervention

• Tailor the intervention to fit within the appropriate policies, standards and guidelines.
• Engage and communicate with relevant stakeholders including staff, patients, family and carers to promote and facilitate adoption of the new intervention.
• Consider implementing a plan-do-study-act cycle from the ‘how to’ guide in which interventions are introduced and tested in the real work setting, in a sequence of repeating, smaller quality cycles.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

What did and didn’t work

• Monitor patient outcomes following the adoption of a new intervention.
• Measure the impacts of translating evidence in your current practice.
• Outline an evaluation to measure outcomes and demonstrate any improvement.

Maintaining the intervention

• Adapt and integrate the new intervention within the current systems taking into account funding and resources.
• Ensure all new staff receive ongoing training.
• Maintain ongoing communication, engagement and partnerships with relevant stakeholders and the broader network.

Evidence-based Practice (EBP) is a clinical-decision making process in healthcare, based on solving problems using the best scientific evidence combined with the best experiential evidence. EBP changes the way that nurses practice.

Everyday nurses encounter clinical experiences that challenge them and demand the best of clinical education and experienced problem-solving. Healthcare is extraordinarily challenging and changes at a rapid pace.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Prospective and established nurses who desire longevity in the field do well by acquiring core knowledge such as the nursing education offered by Franciscan Missionaries of Our Lady University’s online RN to BSN program.

What is Evidence-Based Practice in Nursing?

EBP is a problem-solving approach which implements theory-derived, research-driven evidence to make informed clinical decisions. All clinical judgments should include consideration of the following three factors:

• Best practice evidence

• Patient preferences and individual needs

• Clinical expertise

EBP replaces procedures and policies that no longer make sense. Decisions are made based on clinical excellence and data instead of tradition or authority. “Because this is the way we’ve always done it” is no longer a viable answer for nurses anywhere.

Why is Evidence-Based Care Important?

Nursing work is never dull; no two patients are the same, even when they have similar diagnoses. A nurse not only has to understand the diagnoses, but also interpret the nuanced differences between patients. Nursing is part science and part art, with inspiration and innovation, heavily supported by an excellent education.

Nurses encounter problems, questions, and situations daily that require them to interpret information in a clinically useful way for optimal patient outcomes. Nurses synthesize knowledge and skills acquired from education, long-standing nursing practices and personal experience. EBP helps nurses review and revise their practice to increase patient outcomes. EBP changes the way nurses care for patients.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Examples of How Evidence-Based Care Changed Nursing

There are many examples of how evidence-based practice has changed the ways nurse provide care. The following are just a few things that have changed due to nurse’s observations and input to improve care.

• Nurses no longer milk chest tubes

• Intramuscular injections are no longer aspirated due to the possibility of tissue trauma

• BRAT (Bananas, Rice, Applesauce, Toast) is no longer recommended

• Implementation of nurse-driven protocols

• Turning every two hours is no longer standard; patient acuity determines the schedule

• Infection control

• Use of smaller catheters for infusion of packed red blood cells to promote patient comfort

Evidence-based practice integrates the best evidence available with nurse’s practical experience and knowledge. It takes into consideration the patient’s preferences and combines these variables for better outcomes. It is not a static event, but rather a fluid process of problem-solving.

EBP takes into account the nurse’s clinical expertise while honoring a critical, systematic approach to finding the most relevant evidence to solve clinical problems. EBP is the platform on which nurses can excel and advocate for their patients, but it is a job far from being done.

There is still much to learn, much to do and many clinical problems to solve, and an online RN to BSN education that prepares the licensed RN for the future is a great place to start. As healthcare evolves and expands to include increased technology and greater medical complexity in patients, nurses will need to pull out all the stops and engage all that they have to do superb work. EBP provides the framework to do just that.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

What Is Evidence-Based Practice?

Evidence-based practice (EBP) is a patient-centered approach founded on independent scientific research, clinical expertise and patient experiences. Nurses and other healthcare providers who utilize this approach must consider the most recent healthcare research when determining the course of care and treatment.

The field of nursing earned recognition as an applied science in the 1960s, and research efforts intensified. The accumulation of research may have led to increasing knowledge levels; however, healthcare leaders began to express concern at the widening gap between the ideal healthcare environment and what patients were actually experiencing. Moreover, they were worried that the growing amount of scientific background and research was not being transferred and applied consistently to clinical patient care, thereby failing to meet the goal of improved and consistent outcomes.

In response, the Institute of Medicine (IOM) — which changed its name to the National Academy of Medicine (NAM) in 2015 — issued Crossing the Quality Chasm: A New Health System for the 21st Century in 2001. This report noted prior research that indicated the current system was causing preventable harm. It also reiterated the need for uniformity across the healthcare system to ensure that all patients were receiving the highest quality of care no matter where they sought treatment. To reach that goal, it was theorized that incremental changes would not be enough — a complete overhaul would be necessary. One of the recommendations was to implement EBP.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

How Is Evidence-Based Practice Used in Nursing?

The transition to EBP has impacted nursing in several ways. First, nursing education has changed. Colleges and universities have altered their BSN program curricula to incorporate EBP. Students pursuing the degree, even through accelerated online RN to BSN programs, will find coursework that focuses not only on increasing a nurse’s overall knowledge base, but also on the importance of professional accountability. These programs emphasize critical thinking skills and encourage students to consider the patient’s clinical, cultural, religious and socioeconomic backgrounds, as well as relevant scientific research.

The growing use of EBP has also led to a greater interest in and emphasis on nursing research. While bachelor’s programs may contain at least one course related to nursing research, students may find it beneficial to further hone their skills. Although research may not frequently be a task assigned to entry-level nurses, it can be helpful to know about new and emerging scientific data since it can have a more direct influence on current and future professional nursing practices than in the past.

Becoming familiar with various research methodologies may prepare nurses for careers away from the bedside. With the accumulation of clinical experience and the completion of a Master of Science in Nursing (MSN) degree, nurses will find many more opportunities in research. These roles are often more independent and require less patient contact. Nurse researchers may design studies or trials, collect and review data, and write and publish their findings.

What Are the Benefits of Evidence-Based Practice?

The ultimate goal of the EBP movement is to standardize and improve access and quality of care across the healthcare system. Certain patient and nurse benefits include the following:NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Improved patient outcomes. The heavy focus on raising the overall quality of care may lead to improved outcomes and health for patients. Using the most current healthcare research can help minimize complications associated with chronic illness and prevent additional illness or disease.

Lower costs of care. Roughly one in four Americans are living with multiple chronic illnesses and the cost of caring for these patients can often be substantial. Using EBP’s patient-centered approach may help eliminate unnecessary costs linked to treating chronically ill patients as well as reduce expenses for healthier patients, too.

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Superior nursing skills. Incorporating EBP throughout a nurse’s education and clinical experiences develops more advanced critical thinking and decision-making skills. Nurses are better able to adapt to situations, utilize informatics and work in interdisciplinary teams. They also feel a greater sense of confidence and pride in their work.

Advancing Patient Care

Evidence-based practice has become an integral component of delivering high-quality, patient-centered care. Nursing students in an RN to BSN program will learn EBP theories and apply this knowledge in their careers. Offering benefits to both patients and nurses, evidence-based practice is helping to lead the way in advancing patient care.

Nursing has evolved over many years to become a respected field. Nursing became viewed an applied science in the 1960s — the use of the scientific process to determine best practices was not consistent until much later.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Best practices, which receive plenty of focus in RN-BSN online programs, are nursing practices that are based on high-quality scientific evidence indicating that a particular practice benefits patients.

The Institute of Medicine’s 2001 report titled Crossing the Quality Chasm acknowledged the lack of the use of scientific evidence in healthcare practices. It noted that the massive base of medical knowledge available was not being effectively utilized and the public was not benefiting from it as much as it should be.

The emphasis on the use of available evidence to determine best practices began in the 1990s. Efforts made at that time to encourage individual healthcare professionals to independently examine and analyze studies to answer their own clinical questions were not very effective.

Later in the 1990s, the use of systematic reviews analyzing the results of multiple studies and clinical practice guidelines became more widespread, and continue today.

What Are the Benefits of Evidence-Based Care?

Consistency in Care

Care is no longer based in tradition, but in evidence that helps create standards in healthcare. Both patients and nurses benefit from consistency in the types of interventions that patients receive.

Best practice guidelines are available to guide institutions and healthcare professionals in the creation of policies and individual practice. Patients and their families also feel more secure in having a better idea of what to expect.

Better Patient Outcomes

Patient outcomes improve with the implementation of evidence based care. Infection and complication rates decrease, and fewer preventable events such as falls and pressure ulcers occur.

Some dangerous old nursing practices that were based on tradition were, thankfully, phased out due to new evidence. Nurses no longer smoke in the nurses station, no longer apply antacid powder to wounds, and we now know that infants should not be placed on their bellies to sleep (it was believed that this practice would help prevent choking).NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

An Advancing Career Field

Another benefit of evidence-based healthcare is that the nursing field is gaining more autonomy. Nurses and nurse practitioners are being granted more independence, and are increasingly being permitted to practice to the full extent of their education.

These changes are taking place thanks to the growing body of evidence indicating that nurse practitioners provide safe, effective care that is satisfactory to patients.

Nurses Benefit from Evidence-Based Practice

EBP is now considered essential to the delivery of quality nursing care and has been utilized in everything from hand hygiene to dress code. It connects clinical decision-making to the best current evidence, clinical expertise and patient preference. The purpose of EBP is to reduce variations in practice and standardize healthcare.

As healthcare continues to shift from volume-based to value-based, EBP is becoming even more critical. Baccalaureate-trained nurses are expected to know more than ever about problem-solving and best practices to support patient safety and healthy outcomes.

“Nurses arguably spend more time with the patient than anyone else in healthcare,” said Chief Nursing Officer Christina Dempsey for the patient satisfaction consulting firm Press Ganey. “As such, they are not only the gatekeepers, they are the ‘thin white line’ between patient safety and both the patient experience and sub optimal outcomes — much like police officers are the thin blue line between anarchy and order.”

The Institute of Medicine (IOM) set a goal of 90 percent of all healthcare practice to be evidence-based by 2020. As the United States moves toward the goal, nurses are at the forefront of implementing this evidence-based practice in healthcare. Key to this effort are registered nurses (RNs) who earn Bachelor of Science in Nursing (BSN) degrees and work in direct patient care.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

Origins of Evidence-Based Practice

Historians have linked the earliest use of evidence-based practice to Florence Nightingale and her treatment of sick and injured soldiers during the Crimean War in the 1850s. Among her important insights were connecting poor sanitary conditions and the death rate of wounded soldiers.

In the 1970s, British researcher Archie Cochrane published Effectiveness and Efficiency: Random Reflections on Health Services, which criticized the lack of credible evidence behind many commonly accepted healthcare interventions. Cochrane became widely known as the father of EBP. In the 1990s, Dr. Gordon Guyatt, an internal medicine specialist, coined the term evidence-based medicine.

Models of EBP

In the past two decades, researchers have created dozens of EBP theoretical models and frameworks to help educators and clinicians advance the science behind EBP and facilitate changes. In general, all of the models follow the same basic structure:

1. Identify the problem
2. Review and analyze research that addresses the problem
3. Evaluate the need for change and potential barriers
4. Consult with stakeholders who will support the practice change
5. Implement the change
6. Evaluate outcomes

Because no single model meets the needs of all healthcare settings, several are commonly used in nurse-led research for quality improvements to healthcare. The most commonly used models are adaptable to a variety of environments:

ACE Star Model of Knowledge Transformation (ACE)

The ACE Star Model is a five-step process that has been used in both educational and clinical practice. ACE is used because it provides a simple yet comprehensive approach:

1. Discovery of key research
2. Summarizing and review of the research studies
3. Translating the studies into clinical application
4. Integrating changes into practice
5. Evaluating the effectiveness of the change

Advancing Research and Clinical Practice through Close Collaboration (ARCC)

The ARCC model focuses on providing healthcare systems with ways to implement and sustain EBP for improved patient outcomes. ARCC contains five steps:

1. Assess organization culture for change readiness
2. Identify barriers to change
3. Identify EBP mentors
4. Implement EBP into practice
5. Evaluate outcomes

Iowa Model

The Iowa Model is intended to provide nurses and other clinicians with guidance while making decisions about day-to-day practice. Frequently used in clinical research, the model encourages clinicians to identify problems or “triggers” and solutions through seven steps:

1. Select topic
2. Form research team
3. Retrieve and develop evidence
4. Grade the evidence
5. Develop an EBP to address the topic
6. Implement the EBP
7. Evaluate outcomes

Benefits of EBP in BSN Nursing

The role of EBP in nursing begins in nursing school, where BSN students are expected to apply critical-thinking skills, professional accountability and clinical knowledge to bedside care. The use of EBP benefits BSN nursing because it provides tangible proof of healthcare successes. Some EBP-based studies have been implemented into practice today:

• Hand Hygiene

Evidence that hand washing reduces the incidence of disease and infection dates to the 1890s when researchers recognized a connection between patient mortality and providers who handled cadavers. After Dr. Ignaz Semmelweis implemented hand washing with chlorine, the rate of patient deaths decreased. His research and subsequent practice launched what has become an essential public health tool.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper

• Dress Code

A Richmond, VA-based hospital changed the nursing staff dress code based on research that found a positive correlation between standardized attire and the identification of staff and the appearance of professionalism. The group recommended nurses wear discipline-specific scrubs (For example, RNs wear solid ciel blue, solid white or a combination and nurse practitioners wear solid teal, solid white or a combination). Based on EBP recommendations, nurses were also issued gold and black tags that identified their professional titles.

• Oxygen for chronic obstructive pulmonary disease (COPD) patients

Researchers found COPD patients must be provided ancillary oxygen despite the previous practice of withholding oxygen. In the past, providers thought ancillary oxygen could cause illness or death in COPD patients. However, EBP has proven oxygen can prevent hypoxia and organ failure.

• Nurse education

In 2003, the IOM published its Health Professions Education: A Bridge to Quality report that stated healthcare providers, including nurses, were not receiving adequate training and education. The IOM included EBP as one of the core competencies for all providers. Since then, nursing education programs have put a significant emphasis on teaching EBPs and methods.

EBP has impacted all realms of healthcare practice, so providers must be prepared to implement new standards based on facts and evidence. Approaches that have been used for decades but have no evidentiary value are on the way out. The top nursing schools, including Duquesne University, use evidence-based practice in nursing and healthcare education.NURS 8500 – Evidence-Based Practice II: Planning and Implementation Essay Paper