Making evidence-based practice a reality in your institution

Impact of evidence and health policy on nursing practice

The story of evidence-based practice in nursing is long, with many successes, contributors, leaders, scientists, and enthusiasts. Nurse educators have great advantages offered from a wide variety of educational resources for evidence-based practice. These resources offer students the opportunity to connect their emerging competencies with clinical needs for best practices in clinical and microsystem changes.

How relevant is the Cochrane Database of Systematic Reviews to nursing care?

Barriers obstructing evidence-based nursing have been explored in many countries. Lack of resources and evidence has been noted as one of these barriers. We aimed to identify nursing care-related systematic reviews published in the Cochrane Database of Systematic Reviews from 1996 until 2009. Using a broad search strategy we identified titles of Cochrane systematic reviews and protocols that focused on nursing care. The abstract of each title was examined and predetermined data were collected and analysed. 1249 titles out of a possible 6244 records were identified as being relevant to nursing care. Most of them focused on newborn and adult populations and related to comparing one intervention with another, and management strategies. The most common nursing specialties represented were internal medicine (34%) and mother and child care (25%). Twenty one percent of reviews published in the Cochrane Database of Systematic Reviews are of direct interest to those involved in nursing care however their relevance was not always obvious.

Steps for successful implementation of proteomic research in the OR

Proteomic studies (ie, the investigation and identification of proteins found in biological samples such as blood and tissue) are at the forefront of the identification of disease biomarkers and the understanding of proteins. These studies promise to enhance diagnostic and prognostic analysis across all disciplines of clinical practice. As the practice of nursing and medicine becomes more preventative in nature and predictive in terms of patient care, successfully integrating and implementing proteomic research will become increasingly important, especially in the OR. It is imperative that perioperative nurses and researchers establish a collaborative process for specimen collection. Steps in establishing and maintaining a successful specimen collection program include implementing and evaluating a protocol, developing good communication, and keeping all participants up to date on the progress of the study.

A conceptual model for growing evidence-based practice

Nursing administration at a small medical center is developing and implementing an evidence-based practice (EBP) model of care to support a culture of quality care, clinical excellence, cost-effectiveness, critical thinking, empowerment of staff, and professional growth. The purpose of this article is to describe a conceptual model for EBP that addresses how to overcome barriers to implementation. Clinician expertise and values, experience, patient preference and expectation, and caring become grounded in a practice environment that must strive to become rooted in clinical research to evolve into a practice that is evidence-based. Education helps to nourish EBP, but leadership, enthusiasm, mentorship, clinical inquiry, and reflective practice make EBP thrive. The EBP ambassadors branch out to each department to grow journal clubs, EBP Web pages, EBP projects, research utilization projects, and staff-led practice reviews. The fruits are quality patient care and outcomes, clinical excellence, cost-effectiveness, critical thinking, empowerment of staff, and professional growth.

"Research to Practice": A Practical Program to Enhance the Use of Evidence-Based Practice at the Unit Level

PURPOSE/OBJECTIVES

To assist clinical nurses in translating research into clinical practice.

DATA SOURCES

City of Hope Quality-of-Life (QOL) Model to guide presentations and discussion, research utilization theories, and evidence-based practice literature.

DATA SYNTHESIS

Based on percentage of individual participant involvement, the four domains of QOL, and a knowledge survey.

OUTCOMES

Attendance, discussion, QOL domain ranking, satisfaction, and pre- and postknowledge scores. Attendance averaged 13 individuals; average discussion participation was 54%. The psychological QOL domain was most important (58%), and discussion averaged a score of 3 (1 = slow to 5 = lively). A one-point increase (scale 1-5) measured a change in knowledge.

CONCLUSIONS

The challenge for nursing assessment is to fully address patient issues in the psychological domain.

IMPLICATIONS FOR NURSING

A practical program can be formulated to bring evidence-based practice to the clinical setting.

Inquiry in Baccalaureate Nursing Education: Fostering Evidence-Based Practice

With the increasing emphasis on evidence-based nursing practice, nurse educators need to more fully implement teaching strategies that help students gain critical thinking skills related to inquiry and understand the importance of evidence-based nursing practice. Research and scholarship emphases in one baccalaureate nursing program, student-identified benefits, and challenges associated with incorporating inquiry across the curriculum are described in this article. In clinical journal entries, students described the following benefits associated with curricular emphasis on inquiry: increased interest in evidence-based nursing practice and participating in the generation of research; enhanced critical thinking skills through the development of knowledge, experience, and competencies; increased motivation to continue professional growth and development by participating in lifelong learning; the desire to become better consumers of research findings; better understanding of the "real world" of clinical research; and increased desire to pursue graduate studies in nursing. The challenge to promote student growth toward competence in the application of evidence-based principles in clinical practice is ongoing.

Bridging the divide: a survey of nurses' opinions regarding barriers to, and facilitators of, research utilization in the practice setting

BACKGROUND

Many researchers have explored the barriers to research uptake in order to overcome them and identify strategies to facilitate research utilization. However, the research-practice gap remains a persistent issue for the nursing profession.

AIMS AND OBJECTIVES

The aim of this study was to gain an understanding of perceived influences on nurses' utilization of research, and explore what differences or commonalities exist between the findings of this research and those of studies that have been conducted in various countries during the past 10 years.

DESIGN

Nurses were surveyed to elicit their opinions regarding barriers to, and facilitators of, research utilization. The instrument comprised a 29-item validated questionnaire, titled Barriers to Research Utilisation Scale (BARRIERS Scale), an eight-item scale of facilitators, provision for respondents to record additional barriers and/or facilitators and a series of demographic questions.

METHOD

The questionnaire was administered in 2001 to all nurses (n=761) working at a major teaching hospital in Melbourne, Australia. A 45% response rate was achieved.

RESULTS

Greatest barriers to research utilization reported included time constraints, lack of awareness of available research literature, insufficient authority to change practice, inadequate skills in critical appraisal and lack of support for implementation of research findings. Greatest facilitators to research utilization reported included availability of more time to review and implement research findings, availability of more relevant research and colleague support.

CONCLUSION

One of the most striking features of the findings of the present study is that perceptions of Australian nurses are remarkably consistent with reported perceptions of nurses in the US, UK and Northern Ireland during the past decade.

RELEVANCE TO CLINICAL PRACTICE

If the use of research evidence in practice results in better outcomes for our patients, this behoves us, as a profession, to address issues surrounding support for implementation of research findings, authority to change practice, time constraints and ability to critically appraise research with conviction and a sense of urgency.

The utilisation of continuous veno-venous haemofiltration for the removal of septic mediators in patients with systemic inflammatory response syndrome

Septic shock is the leading cause of morbidity and mortality in critically ill patients. If the mediators responsible for the continuum of the sepsis cascade could be blocked or removed, patient outcome might improve. Researchers have been attempting to eliminate such mediators by continuous veno-venous haemofiltration (CVVH) but, despite over a decade of studies, many obstacles still remain. In this article, a comparison has been made of four similar research studies to ascertain any significant findings. Future research proposals have been considered in conjunction with the role the nurse within critical care might play in what could arguably be considered to be within the medical domain.

Narrative inquiry in a nursing practicum

One approach to creating research-based nursing education is to think and write narratively about the daily life of a BScN program student and her teacher in diverse settings and over time. Gail, as a nurse-teacher, and Faith, as a nursing student and now Public Health Nurse, reconstruct their teaching-learning experiences in an integrated practicum in maternal-child health services as a narrative inquiry. After presenting this reconstruction of experience at a conference on maternal scholarship, further inquiry into their experiences shows how narrative inquiry matters to construction of nursing praxis and to life-long learning as a nurse. Teaching-learning relationships are seen as a template for a student's connections to people experiencing nursing care and to other clinicians. Construction of stories to live by that take into account becoming a nurse, constructing knowledge and enacting caring-healing nursing practices is illuminated through narrative inquiry.

Using evidence-based practice to develop a protocol for postoperative surgical intensive care unit patients

Sixty adult postoperative patients from the surgical intensive care unit with core temperatures <35.4 degrees C, as measured by a pulmonary artery catheter, were randomly assigned to one of three treatment options for hypothermia. Results of this study confirmed findings in the literature that forced warm air generated quickest rewarming times. A rewarming protocol for hypothermic patients was developed and implemented. Performance improvement activity demonstrated high compliance rates with nurses using the rewarming protocol.

Evidence-based practice in action

As Associate Editor for Journal of Pediatric Nursing (JPN), I will be assisting with evidence-based practice (EBP) submissions or other clinically based articles. I welcome questions, works-in-progress for constructive criticism, and finished submissions for review. This article comprises an overview of the EBP process, an EBP submission format for JPN, and 4 examples of EBP in a variety of pediatric clinical settings.