Use of Implementation Science to Advance Nurse-Led Evidence-Based Practices in Clinical Settings

Evidence demonstrates improved outcomes of evidence-based practice (EBP); yet routine implementation remains challenging. Implementation science provides a science-based approach to implementation, but application among nurse-led teams is sparse. This study identified difficulty/success of nursing teams implementing EBPs, and common implementation strategies. Nurses (n = 84) reported difficulty with implementation. Common strategies included engaging leadership, collaborators, highlighting advantages, diverse teams, and staff meetings. Highly successful nurse-led teams reported use of timelines, checklists, auditing/feedback, and hardwiring as effective implementation strategies. Implementation remains the most challenging component of EBP. Nurse-led teams should incorporate implementation science strategies to facilitate successful uptake of EBP in clinical settings.     

The effect of evidence-based practice perception,information literacy self-efficacy,and academic motivation on nursing students' future implementation of evidence-based practice

BackgroundEvidence-based practice (EBP) in nursing is an important tool for promoting quality care and improving patient outcomes. Global evidence suggests that the rate of EBP implementation among nurses and nursing students is low. The effects of EBP perception, information literacy self-efficacy, and academic motivation on nursing students' future implementation of EBP have not been fully explored.PurposeTo examine the effect of EBP perception, information literacy self-efficacy, and academic motivation on future implementation of EBP among pre-registration nursing students.MethodA cross-sectional study used a self-administered structured questionnaire and analyzed data from 148 pre-registration nursing students at a university in central Israel. A hierarchical forced steps regression analysis was conducted to predict future implementation of EBP.ResultsInformation literacy self-efficacy, EBP perception, and intrinsic academic motivation to experience stimulation, may predict EBP future implementation. The model explained 46.3% of the variance.ConclusionThe results indicate the importance of information literacy skills and positive attitudes to EBP, as well as of intrinsic academic motivation, for enhancing future implementation of EBP among nursing students.     

Optimizing nursing care by integrating theory-driven evidence-based practice

An emerging challenge for nursing leadership is how to convey the importance of both evidence-based practice (EBP) and theory-driven care in ensuring patient safety and optimizing outcomes. This article describes a specific example of a leadership strategy based on Rosswurm and Larrabee's model for change to EBP, which was effective in aligning the processes of EBP and theory-driven care.     

Organizational factors that support the implementation of a nursing best practice guideline

BACKGROUND: The context of the healthcare setting may play a crucial role in influencing the implementation of best practice guidelines in nursing. Further study is required to understand these organizational factors. Two variables, organizational culture and leadership, are thought to influence the adoption of best practice guidelines. AIM: A discussion of organizational factors that influence best practice guideline adoption is presented. A small pilot study is provided as an example of methods for further research. METHODS: A quantitative survey of nursing staff was conducted. RESULTS: Results from the pilot study reveal variability in best practice guideline implementation despite the presence of a culture of organizational learning and transformational leadership. CONCLUSIONS: There is beginning evidence in the literature that culture and leadership are key elements influencing guideline implementation. In this pilot work on two inpatient units where a nursing best practice guideline was implemented, a supportive organizational culture and key people leading change were present. Implications for further studies are offered. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing leaders interested in promoting the use of best practice guidelines must pay attention to the organizational context in which nursing care occurs. A supportive culture where learning is valued coupled with transformational leadership may be key factors in the implementation and the sustainability of best practice guidelines.     

Stroke unit Nurse Managers' views of individual and organizational factors liable to influence evidence‐based practice: A survey

The uptake of evidence into practice may be impeded or facilitated by individual and organizational factors within the local context. This study investigated Nurse Managers of New South Wales, Australia, stroke units (n = 19) in their views on: leadership ability (measured by the Leadership Practices Inventory), organizational learning (measured by the Organizational Learning Survey), attitudes and beliefs towards evidence‐based practice (EBP) and readiness for change. Overall Nurse Managers reported high‐level leadership skills and a culture of learning. Nurse Managers' attitude towards EBP was positive, although nursing colleague's attitudes were perceived as less positive. Nurse Managers agreed that implementing evidence in practice places additional demands on staff; and almost half (n = 9, 47%) reported that resources were not available for evidence implementation. The findings indicate that key persons responsible for evidence implementation are not allocated sufficient time to coordinate and implement guidelines into practice. The findings suggest that barriers to evidence uptake, including insufficient resources and time constraints, identified by Nurse Managers in this study are not likely to be unique to stroke units. Furthermore, Nurse Managers may be unable to address these organizational barriers (i.e. lack of resources) and thus provide all the components necessary to implement EBP.     

Navigating the evidence-based practice maze

Aim  This article's purpose is to provide nurses with key points to consider in facilitating informed decision making while navigating the evidence-based practice (EBP) maze.
Background  EBP in nursing evolved from the medical model and continues developing within the holistic nursing paradigm. Inconsistent terminology, multiple applications, and lack of a unifying theory create challenges for nurses.
Key issues  Recognition that multiple knowledge sources to support clinical decision making have merit for facilitating 'best' patient outcomes; EBP must be an internalized value of professional nursing.
Conclusions  Multiple ways of knowing, or evidence, for informed clinical decision making must be considered based on situational context. No hierarchy fits all situations. Nurses must provide support and resources to facilitate nurse empowerment; nurses are accountable for using EBP to enhance patient outcomes.
Implications for nursing management  Effective EBP implementation relies on nurses being cognizant of what current nursing EBP trends are based on and where they are going. Nurses have a key role in facilitating consensus regarding evidence to be used in EBP, and ensuring availability of resources for empowering nurses to be accountable for outcome-oriented patient care through utilizing EBP.     

Increasing nursing research capacity: The roles and contributions of nurse scientists within healthcare systems in the Greater Philadelphia region

PhD prepared nurse scientists within healthcare systems are uniquely positioned to advance nursing science through research and evidence-based practice (EBP) initiatives due to their ability to closely collaborate with nurses and other healthcare professionals in the clinical setting. The purpose of this paper is threefold: 1) to describe the roles and contributions of Nurse Scientists, from their perspectives, in four different health care systems in the Greater Philadelphia area, three of which are Magnet® designated hospitals; 2) to highlight organizational approaches to increase nursing research and EBP capacity; and 3) to explore strategies that Nurse Scientists used to overcome barriers to build nursing research capacity. Nurse Scientists employed in these healthcare systems share many of the same essential roles and contributions focused on developing nursing research and EBP initiatives through education and mentorship of clinical nurses, conduct and oversight of independent research, and dissemination activities. With supportive executive nurse leadership, the Nurse Scientists within each healthcare system employed different strategies to overcome barriers in building nursing research and EBP capacity. Nurse scientists within healthcare settings have potentially powerful positions to generate and apply new knowledge to guide nursing practice and improve outcomes.     

Views on evidence from nursing and midwifery opinion leaders

National registration standards in Australia require nurses and midwives to be educationally prepared to use an evidence-based framework for their practice. These standards assume a shared professional understanding of evidence and, an agreed approach towards educational preparation for evidence implementation. In this study, a qualitative phenomenographic approach is used to explore the ways in which nursing opinion leaders understand ‘evidence’ within the context of evidence-based practice (EBP). Semi-structured in-depth interviews were conducted with 23 nursing and midwifery opinion leaders across the state of New South Wales, Australia. The findings suggest that views of evidence are deeply imbedded within individual clinical, contextual and professional experiences, and are highly variable. Establishing basic consensus on the meaning of evidence for the nursing and midwifery context is fundamental to the successful educational preparation of nurses and midwives for EBP. It is proposed that future evaluations of EBP education in nursing and midwifery examine the assumptions on which such programs are based as individual variation may be a significant factor in both defining and measuring the success of educational interventions for evidence implementation.     

Providing direct care nurses research and evidence-based practice information: an essential component of nursing leadership

staffileno b.a. & carlson e. (2010) Journal of Nursing Management  18, 84–89
Providing direct care nurses research and evidence-based practice information: an essential component of nursing leadership
Aims  This commentary describes the reasons, strategies and benefits of providing direct care nurses with research and evidence-based practice (EBP) education.
Background  A component of nursing leadership is to provide nurses opportunities for professional growth and development, yet this can be challenging during a time when resources are constrained and need to be used wisely.
Evaluation  Our research and EBP education programmes have been evaluated qualitatively, as well as by the number of research/EBP projects implemented.
Key issues  Providing direct care nurses with support and additional education empowers them to seek, critically appraise and integrate research findings into their daily patient care.
Conclusions  Direct care nurses, who participated in our programme, demonstrated a strong desire to learn about research and EBP so they could practice using evidence-based care with confidence, thus transitioning from a 'tradition-based' care approach to an evidence-based way of providing care as the standard for nursing practice.
Implications for Nursing Management  Providing a dedicated time for additional education sends a clear message that research and EBP are important elements embedded in patient care. The organisation, then, is seen as an environment that emphasizes the value of research and EBP at the unit and organisational level.     

The Australian experience of nurses' preparedness for evidence-based practice

Aim  This study aimed to determine current knowledge and attitudes towards evidence-based practice (EBP) among pre- and post-registration nurses in New South Wales (NSW), Australia.
Background  Educational and clinical strategies for EBP in nursing assume a readiness to interpret and integrate evidence into clinical care despite continued reports of low levels of understanding and skill in this area.
Method  Perceptions of EBP were examined through a self-complete, anonymous postal survey distributed to 677 (post-registration) clinical nurses and to 1134 final year (pre-registration) nursing students during 2002 and 2003.
Results  A completed survey was returned by 126 post-registration and 257 final year nursing students (combined 21% response rate). Both pre- and post-registration nurses had a welcoming attitude towards EBP. Pre-registration nurses expressed more confidence in their EBP skills but self-rated knowledge and skill were low to moderate in both groups.
Conclusion  Nurses in Australia are clearly supportive of EBP but it is incorrect to assume that even recent graduates have a level of knowledge and skill that is sufficient to permit direct engagement in evidence implementation.
Implications for nursing management  Among a range of clinical supports, nurse managers and leaders can contribute to evidence-based health care by understanding the EBP knowledge and skills of their workforce and demanding a more practical approach in nursing education towards evidence-based guidelines and summaries appropriate to the clinical context.     

Professional nursing societies and evidence-based practice: strategies to cross the quality chasm

The Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health Care System for the 21st Century nearly 10 years ago. Nursing societies are in a unique position to promote evidence-based practice (EBP). The purpose of this article is to describe EBP strategies that nursing societies can use to improve the quality of health care, thus decreasing the gap between research knowledge and practice. Nursing societies can take the lead in two key EBP activities: (1) development of evidence-based syntheses, systematic reviews, and guidelines for EBP; and (2) development, implementation, and testing strategies for these EBP resources to become available and used in clinical decision-making. The Oncology Nursing Society will be discussed as an exemplar of developing EBP programs and increasing knowledge of EBP and practice change resources for its members. The discussion stresses the importance of nursing society members and leaders in guiding their societies to contribute to the closing of the US health care quality chasm.     

Using Appreciative Inquiry to promote evidence-based practice in nursing: the glass is more than half full

It is now understood that successful implementation of evidence-based practice (EBP) requires a focus on the context of the care setting. While the focal point of many reports is the limitations and barriers, this paper proposes a new approach to "making EBP happen." Appreciative Inquiry (AI), both a method of social research and an organizational development or change intervention, is a novel means to elicit enthusiasm and support for EBP in nursing. Readers will be introduced to the theoretical foundations and assumptions as well as the "4-D Model" of AI. It is proposed that the advanced practice nurse (APN) is in a key position to introduce and support this intervention in healthcare organizations to promote the successful implementation of EBP.     

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.     

Clinical leadership and pre-registration nursing programmes: A model for clinical leadership and a prospective curriculum implementation and evaluation research strategy

AimTo present for wider debate a conceptual model for clinical leadership development in pre-registration nursing programmes and a proposed implementation plan.BackgroundGlobally, leadership in nursing has become a significant issue. Whilst there is continued support for leadership preparation in pre-registration nursing programmes, there have been very few published accounts of curriculum content and/or pedagogical approaches that foster clinical leadership development in pre-registration nursing. A doctoral research study has resulted in the creation of an overarching model for clinical leadership.DesignA multi-method research study using theoretical and empirical literature 1974–2015, a focus group, expert opinion and a national on-line survey.DiscussionA conceptual model of clinical leadership development in pre-registration nursing programme is presented, including the infinity loop of clinical leadership, an integral curriculum thread and a conceptual model: a curriculum-pedagogy nexus for clinical leadership. In order to test out usability and evaluate effectiveness, a multi method programme of research in one school of nursing in Australia is outlined.ConclusionImplementation of the proposed conceptual model for clinical leadership development in pre-registration nursing programmes and a programme of (post-doctoral) research will contribute to what is known about curriculum content and pedagogy for nurse academics. Importantly, for nursing students and the profession as a whole, there is a clearer expectation of what clinical leadership might look like in the novice registered nurse. For nurse academics a model is offered for consideration in curriculum design and implementation with an evaluation strategy that could be replicated.     

Making evidence based practice a reality for mental health nursing

In recent years, efforts have been directed towards making mental health nursing more evidence-based. Making evidence based practice (EBP) a reality in modern health services requires due attention to service planning and management. It is acknowledged that there are many challenges and barriers to implementing EBP as outlined in this article. However, by using an example from our mental health service and drawing upon the literature, we show that a variety of techniques can be used to incorporate EBP into everyday practice. A combination of approaches is recommended, including education and training, leadership programs, research units, dissemination of research findings and structural changes to draw upon the expertise of key clinical, education, management and research staff.     

Implementing the Critical Care Pain Observation Tool using the Iowa Model

Utilization of the Iowa Model of evidence-based practice (EBP) helps to facilitate change in nursing care. This was observed when an alteration in pain-rating assessment scales needed to be implemented at St. Joseph's Hospital Health Center in Syracuse, NY Research showed that the Critical Care Pain Observation Tool (CPOT) was psychometrically sound in assessing pain in the nonverbal (unconscious, unresponsive, and sedated) intensive care unit patient population. Successful implementation of a CPOT pilot program in the surgical intensive care unit at St. Joseph's was undertaken using the Iowa Model of EBP. Application of the Iowa Model provided a systematic framework for changing nursing practice by incorporating critical thinking, clinical inquiry and judgment, multidisciplinary collaboration, and facilitation of learning. As evidenced by implementation of the CPOT, organizational implementation of EBP using the Iowa Model positively impacts change across an entire healthcare continuum through the improvement of patient care processes.     

The changing face of academic nursing: Nurturing diversity,inclusivity, and equity

This paper captures collective experiences of nursing and organizational leaders in creating organizational cultures attentive to diversity, inclusivity, and equity in schools of nursing. Within a cultural proficiency framework, exemplars and leadership lessons are shared. Most importantly, what it takes organizationally to start the ongoing journey towards cultural proficiency is explored. Ensuring the intentional systematic change at multiple levels facilitates sustainability when leadership changes occur.     

中文版循证护理信念和实施量表的信效度分析

目的 译制中文版循证护理信念和实施量表,并检验其在国内护理人员中的信效度.方法 将Melnyk等研制的循证信念和实施量表进行汉化和修订,形成中文版循证护理信念和实施量表,对330名护理人员进行调查,采用项目分析测定量表各条目的鉴别能力,并测评其信效度.结果 中文版循证护理信念和实施量表包括两部分,信念量表含16个条目,3个因子模型拟合较好,各条目与其所属维度的相关系数为0.629 ～0.870,Cronbach＇s α系数为0.895;实施量表含18个条目,2个因子模型拟合较好,各条目与所属维度相关系数为0.795 ～ 0.997,Cronbach＇s α系数为0.972.结论 修订后的中文版循证护理信念和实施量表有较好的信效度,可用于评价护理人员循证护理信念及实施水平.