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.     

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.     

Evidence-based practice: implications and concerns

Aims The aim of this paper was to undertake a brief critical appraisal of evidence‐based practice (EBP) as it is currently perceived in health care settings. Background The past two decades have seen EBP become increasingly important in health care planning, clinical thinking, and choice of treatments. It is based on scientific rationalism and adherents claim that decisions based on EBP are superior to those based on other approaches to care. Concerns are now being expressed that positivistic approaches to health care fail to take into account people’s preferences, their internal resources and their personal understandings of health and wellbeing. It has been argued that there may be multiple types of evidence, all of which have a part to play in the formulation and execution of health care. Methods After a literature search, this paper argues that whereas EBP may be useful in treating conditions that have a biological cause, it may be less helpful in understanding and treating conditions that have their origins in the social, psychological or spiritual domains. Results The nature, strengths and limitations of evidence‐based practice is discussed in this paper. Nurses are encouraged to develop the critical skills of evaluating EBP in the lives and experiences of the people they care for. Conclusions Evidence‐based practice has a part to play in improving the treatment provided for patients. Nonetheless, nurses should be aware of other kinds of evidence, and appreciate that any single approach to determining care, no matter how popular, is likely to lead to a service that does not truly meet the complex individual needs of patients. Implications for nursing management In order for evidence‐based practice to be safe, the nursing workforce must be able to evaluate the strength and relevance of research findings, and be able to understand that there are different kinds of evidence which should be called upon in order to respond sensitively and appropriately to the preferences of patients. A responsive workforce embraces multiple ways of thinking, respects different paradigms of care, and is able to respond to and respect the forms of care people value and seek.     

Critical Thinking and Evidence-Based Practice

Critical thinking (CT) is vital to evidence-based nursing practice. Evidence-based practice (EBP) supports nursing care and can contribute positively to patient outcomes across a variety of settings and geographic locations. The nature of EBP, its relevance to nursing, and the skills needed to support it should be required components of baccalaureate education and must be introduced early in students' development as independent, self-directed learners and as professional nurses. Among the knowledge, skills, and processes needed to support EBP, CT is paramount. The development of CT can prepare nurses with the necessary skills and dispositions (habits of mind, attitudes, and traits) to support EBP. The intents of this study were to explore the importance of CT as an essential skill to support EBP and to describe some of the strategies and processes considered key to the ongoing development of CT.     

循证护理:理论与实践

长期以来 ,护理实践的特点就是按照工作程序提供护理服务 ,在用科学证据指导临床护理决策和行动方面存在局限性。在讲求证据的年代 ,护士应积极寻求现时的证据来更新知识结构 ,增强解决问题的能力 ,为病人提供高效优质的护理 ,以满足 2 1世纪循证的要求 ,迎接所面临的挑战。循证护理实践就是实现此目标的一个很好的方法。文章从认识循证医学的内涵及以科学证据为基础的实践对临床护理服务影响的角度出发 ,主要讨论证据的质量分级、循证护理实践的主要步骤及其与临床路径的相互关系、我国循证护理实践现状、护理人员实施循证护理面临的挑战。     

Barriers to Evidence-Based Practice Utilization in Psychiatric/Mental Health Nursing

Many psychiatric/mental health nursing (PMHN) practices have been affected by old traditions and haphazard trial and error instead of by established scientific evidence. The purpose of this article is to explore and analyze the barriers surrounding evidence-based practice (EBP) in PMHN. I identify some strategies to overcome these barriers in an attempt to incorporate EBP within the framework of PMHN services. Barriers explain the lack of EBP in today's PMHN environment. The barriers identified in this research are: the nature of the evidence, the contribution of the psychiatric nursing researchers to EBP, the personal characteristics of psychiatric nurses, and organizational factors. While the barriers to EBP for PMHN practice are clearly apparent, the challenge, now, is to build up creative strategies through which psychiatric nurses are better able to provide EBP care as part of their everyday performance. Adaptation of a more dynamic form of EBP, increasing the number of PMHN researchers, conducting clinical research projects, choosing suitable journals for publication, training the psychiatric nurses about computer skills, integrating the EBP principles into nursing curricula, developing journal clubs, and offering organizational facilitators are essential prerequisites for the achievement of EBP in the PMHN field. It is no longer justifiable for psychiatric nurses to be deficient in knowledge and skill since the advantages of EBP for patients are well-documented.     

Creating an environment to implement and sustain evidence based practice: A developmental process

Background

Elements of evidence based practice (EBP) are well described in the literature and achievement of EBP is frequently being cited as an organisational goal. Despite this, the practical processes and resources for achieving EBP are often not readily apparent, available or successful.

Purpose

To describe a multi-dimensional EBP program designed to incorporate evidence into practice to lead to sustainable improvement in patient care and ultimately patient outcome.

Implementation strategies

A multi-dimensional EBP program incorporating EBP champions and mentors, provision of resources, creation of a culture to foster EBP and use of practical EBP strategies was implemented in a 22-bed intensive care unit (ICU) in a public, tertiary hospital in Brisbane, Australia. The practical EBP strategies included workgroups, journal club and nursing rounds.

Achievements

The multi-dimensional EBP program has been successfully implemented over the past three years. EBP champions and mentors are now active and two EBP workgroups have investigated specific aspects of practice, with one of these resulting in development of an associated research project. Journal club is a routine component of the education days that all ICU nurses attend. Nursing rounds is now conducted twice a week, with between one and seven short-term issues identified for each patient reviewed in the first 12 months.

Conclusions

A multi-dimensional program of practice change has been implemented in one setting and is providing a forum for discussion of practice-related issues and improvements. Adaptation of these strategies to multiple different health care settings is possible, with the potential for sustained practice change and improvement.     

Key steps in implementing evidence-based practice: asking compelling,searchable questions and searching for the best evidence

From the searches presented, it can be seen that there are times when scientific studies will not be available to answer burning clinical questions. If systematic reviews, evidence-based guidelines, and individual studies are not available, clinicians must then turn to expert anecdotal evidence to guide their decision-making process and interventions. As further randomized controlled trials are conducted to evaluate nursing interventions, more scientific evidence will become available to guide nursing practice. However, it is important to remember that EBP not only encompasses evidence from research and its appraisal, but also includes patient preferences and expertise by the clinician. Because a meta-analysis indicated that patients had 28% better outcomes when nursing interventions were based on scientific evidence rather than interventions that were steeped in tradition (Heater, Becker, & Olson, 1988), it is essential that nurse practitioners and nurses have the appropriate knowledge and skills to translate evidence from research into practice. Asking searchable questions and knowing how to search for and find the best evidence are two key steps in delivering the highest quality of evidence-based nursing care to patients and their families.     

Which nursing issues need a European guideline: proposal for respiratory management.

Over the past 30 years, nursing care and health systems have undergone significant changes in many aspects. Particularly, in the last decade, research and the expansion of Evidence-Based Practice (EBP) have played a significant role in this process. EBP is the application of the best available evidence, which in practice means more effective interventions, more efficient use of resources and fewer side effects for patients. From a research point of view, EBP can facilitate the identification of knowledge gaps and thereby help establish research priorities. Furthermore, research evidence may suggest that a change in practice is necessary. When this occurs, one of the best ways to implement such change is through the use of guidelines. Clinical Practice Guidelines (CPG) are "systematically developed statements to assist practitioner decisions about appropriate healthcare for specific clinical circumstances". Whenever possible, CPG help to infuse research into practice and to promote quality and standardisation of care. Nursing care will have a considerably greater impact if evidence-based care is applied. For this reason, it is important to identify the available evidence of respiratory management in order to establish nursing CPG across Europe. The aim of this paper is to analyse the framework in which these guidelines should be applied and to identify which nursing issues should have CPG. Based on the North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC) and the Nursing Outcomes Classification (NOC), this study establishes the main nursing diagnoses for a patient with Acute Respiratory Failure (ARF). Moreover, the current situation regarding respiratory management and the safety of nursing practice procedures are described.     

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.     

Evidence-based practice: to be or not to be, this is the question!

Evidence‐based nursing is the current fashion. It is being touted as the mechanism to achieve best practice in the clinical setting. But while evidence‐based practice (EBP) is being presented in the literature, discussed at nursing practice forums, and evidence‐based centres of excellence have developed, there seems to be very little impact in the practice that nurses deliver on a daily basis. The case in point is the collection of vital signs. While not historically a nursing skill, over the last 60 years it has become an integral component of practice in the postoperative general surgical setting. The evidence to support these practices is scant. Policies and text purport traditional routine‐regulated practice without substantive evidence to support their claims. These polices are being used to control rather than support EBP. In conjunction with the traditional practice of vital sign collection and the culture of the clinical settings, the policies are limiting opportunities for clinicians to make individual decisions about care delivery based on the unique needs of each patient. Rather than focusing on EBP as the solution to the development of best practice, is it not time to change the focus to real strategies that will assist in achieving best practice? These include the creation of rigorous relevant evidence, the valuing of clinical expertise and the changing of the cultures in which nurses develop and practice.     

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.     

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.     

Nursing research committee makes plans for the coming year.

Evidence-based practice (EBP) enhances the care of patients and families by guiding nurses in their patient care. Nursing leaders, health care administrators and policy-makers are increasingly requiring that nursing practice be based on the best available evidence. Murdoch (2004) stated that a review and synthesis of existing research is essential to identify the best available evidence. Koop (2002) further reflected on the challenges faced by oncology nurses when there are clinical situations for which there is little or no empirical evidence on which to base nursing decisions. A need to learn skills and gain confidence in identifying the best available evidence frequently motivates staff nurses and clinicians to learn more about critical appraisal of the research literature. At the McGill University Health Centre (MUHC) these needs have prompted nurses to enrol in the research utilization (RU) course that the health centre offers. This column will outline the context and components of the RU course and summarize feedback from participants. Challenges and limitations of this strategy and its relationship to oncology nursing practice are highlighted.     

A research course to promote evidence-based nursing practice.

Evidence-based practice (EBP) enhances the care of patients and families by guiding nurses in their patient care. Nursing leaders, health care administrators and policymakers are increasingly requiring that nursing practice be based on the best available evidence. Murdoch (2004) stated that a review and synthesis of existing research is essential to identify the best available evidence. Koop (2002) further reflected on the challenges faced by oncology nurses when there are clinical situations for which there is little or no empirical evidence on which to base nursing decisions. A need to learn skills and gain confidence in identifying the best available evidence frequently motivates staff nurses and clinicians to learn more about critical appraisal of the research literature. At the McGill University Health Centre (MUHC), these needs have prompted nurses to enrol in the research utilization (RU) course that the health centre offers. This column will outline the context and components of the RU course and summarize feedback from participants. Challenges and limitations of this strategy and its relationship to oncology nursing practice are highlighted.     

Giving health care to minority patients

Health care is usually thought of as a basic right of each individual. This so-called basic right is denied to many mainly because of their economic situation and the color of their skin. There is a need for more blacks, Indians, Mexican-Americans, Puerto Ricans, and Asians in the health care field. The numbers are low and the training process slow. Time is needed to prepare ethnic people of color. Since most of the deliveries of health care are white, these white workers must become sensitive to the traditions, values and attitudes of the ethnic groups of color. Schools of nursing are beginning to include cultural differences in nursing curriculums, but the majority of the nurses who practice are not aware of and are not sensitive to the needs of nonwhite patients. Nursing must help solve problems of the ethnic groups of color. Nurses must become personally involved in the injustices of health care. As Marie Branch states, there must be "personal reeducation." When this occurs, health care to the minority client will improve.     

Leveraging EBP to Establish Best Practices,Achieve Quality Outcomes,and Actualize High Reliability: Building EBP Competency Is Not Enough

Health care in the United States has been in a critical state for decades and the recent pandemic has added additional stress to a system that is underpinned by widespread variation in practice and care. Evidence-based practice (EBP) is a methodological, problem-solving approach to identify best practices that, when implemented and sustained, leads to quality outcomes, and actualization of true high reliability. To reap the benefits of EBP, however, leaders must do more than simply build EBP competencies. This article provides clarity, guidance, and resources for leaders who are beginning or advancing integration of EBP in their organizations.     

Evidence based practice and its critics: what is a nurse manager to do?

o'halloran p. , porter s. & blackwood b. (2010) Journal of Nursing Management 18, 90–95
Evidence based practice and its critics: what is a nurse manager to do? Aim(s) The purpose is to discuss the arguments against the evidence based practice (EBP) movement and suggest how nursing management might respond. Background EBP is a pervasive approach to directing and regulating nursing care. There are, however, fierce critics who argue that it is fundamentally flawed and detrimental to patient care. Evaluation We consider some of the more radical criticisms of EBP, weighing the arguments and reflecting on the extent to which alleged short-comings are supported in the literature. Postmodernist critics are amongst the most vocal and are therefore our principal focus. Key issue(s) ‘Best evidence’ implies a hierarchical approach to knowledge which excludes other forms of evidence that are needed to understand the complexity of care. Evidence based guidelines tend to stifle critical thinking amongst nurses. Conclusion(s) While EBP is increasingly open to a range of research methodologies, it still largely subscribes to a hierarchy of evidence, even though this approach to addressing the complexities of healthcare is limiting. Although the EBP approach can be shown to stifle critical thinking, this is not inherent to the approach, which can lend itself to supporting professional nursing practice. Implications for nursing management Nursing managers should neither abandon EBP nor accept it uncritically.     

Genetics and nursing: the interface in education, research, and practice

Genetics is affecting all of health care, including nursing. The way in which nurses think about planning health care must be seen now through a "genetic eye" or lens, and nurses must learn to "think genetically." While efforts to integrate genetics into nursing began in earnest in the early 1980s, this effort did not accelerate until the mid-1990s. Before nursing can fully incorporate genetic knowledge into education and practice in a meaningful way, the ways in which genetics will influence health care must be understood. The basic knowledge, skills, and attitudes needed by health professionals are discussed as well as their integration into education and practice. Opportunities for nursing research in genetics are presented as are possible directions. Recommendations for facilitating the integration of genetics into nursing education, practice, and research are also presented.     

Development of the Massachusetts School Nurse Research Network (MASNRN): A Practice-Based Research Network to improve the quality of school nursing practice.

When school nurses embrace evidence-based practice (EBP), higher-quality care is provided to students, their families, and the larger community. Despite this, school nursing has been slow to embrace EBP. Practice-Based Research Networks (PBRNs), which capitalize on the combined strengths of clinicians and researchers to study clinical questions, are one approach to overcoming barriers towards advancing evidence-based practice (EBP) in school nursing. This article will briefly review EBP and PBRNs. The development of Massachusetts School Nurse Research Network (MASNRN), a PBRN designed to investigate health issues common across schools and to validate school nursing practice, will then be described. Details regarding MASNRN's mission, governance, communications systems, staffing, and network maintenance and funding will be explicated. MASNRN can serve as a model for PBRN development within the broader school nursing community.