Promoting evidence-based practice: an organizational approach

AIM: To examine factors influencing the achievement of evidence-based practice. BACKGROUND: This paper reports on the approach taken by a large teaching hospital in England to promote evidence-based practice. A summary of initiatives spanning a 5 year period is presented in order to set the scene for a recent survey of nurses to review progress made. Consideration is given to how the findings from the survey have been used to inform policy and practice. METHODS: A survey by self-completed questionnaire was undertaken with a sample of clinical nurses (n = 330). The questionnaire examined the extent to which nurses utilised different sources of knowledge to inform their practice; perceived barriers to accessing evidence-based information and effecting change in practice; and a self-assessment of core skills necessary to underpin evidence-based practice. FINDINGS: Nurses relied most heavily on experiential knowledge gained through their interactions with nursing colleagues, medical staff and patients to inform their practice. Organisational information in the form of policies and audit reports was drawn upon more frequently than research reports. Lack of time, resources and perceived authority to change practice influenced the extent to which nurses utilised formal sources of evidence. Whereas nurses were relatively well skilled at accessing and reviewing research evidence, they were less confident about their ability to change practice. CONCLUSION: Health care organisations need to consider multiple strategies to facilitate and promote evidence-based practice. Managerial support, facilitation, and a culture that is receptive to change are essential.     

Leadership strategies: inspiring evidence-based practice at the individual, unit, and organizational levels

This article describes innovative educational strategies used by one organization to simultaneously develop leadership skills and evidence-based practice. The methods were theory-driven and designed to positively affect the nursing culture at the individual, unit, and organizational levels. Case studies, outcomes, and lessons learned are also included.     

Evidence-based practice, step by step: sustaining evidence-based practice through organizational policies and an innovative model

The team adopts the Advancing Research and Clinical Practice Through Close Collaboration model.This is the 12th and last article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When it's delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The complete EBP series is available as a collection on our Web site; go to www.ajnonline.com and click on Collections.     

Use of evidence-based practice in the neonatal intensive care unit

The process change described is an ongoing project in the HICN. Through this process we found that developmentally sensitive care can be accomplished as early as the time of birth by minimizing trauma to ELBW infants, keeping them nested with minimal handling. This also supports the goal for this population of minimizing cold stress and its effects. Gentle ventilation can be achieved in the delivery room by understanding physiology and the effects of ventilation on the ELBW lung tissue.     

Diffusion of innovation: the leaders' role in creating the organizational context for evidence-based practice

Successfully leading change represents one of the most, if not the most, challenging aspects of a leader's role. The traditional top-down command and control structures and processes present in healthcare institutions and nursing are the enemies of effective change. Transitioning from traditional structures to structures that are more of a partnership between point-of-service staff and administrators is the foundation for creating an evidence-based practice culture.     

Implementing evidence-based nursing practice in the pediatric intensive care unit.

With the widespread use of central venous catheters in children, the incidence of catheter-related bloodstream infections (CR-BSIs) is increasing. Current evidence-based practice strategies to decrease CR-BSIs include using maximum barrier techniques during insertion, practicing good hand hygiene, performing skin antisepsis with 2% chlorhexidine, using a chlorhexidine-impregnated patch (CIP) covered by a semipermeable polyurethane dressing, and promptly removing catheters when no longer needed. Implementation of evidence-based practice bundles, along with monthly monitoring of infection surveillance, has resulted in significant decreases in the average rates of CR-BSIs per 1,000 catheter days in many pediatric intensive care units.     

Excellence in nursing practice

One of the most influential pieces of nursing research in recent years has been the work of Benner (1). She uses a variety of techniques to illuminate and illustrate nursing's complexity. In so doing, she has contributed to that growing body of evidence which helps to show why and how nursing is valuable. Benner often cites vignettes of nursing actions to demonstrate particular nursing interventions, and to analyse skills and knowledge the nurse is using. Vignettes are not designed to be comprehensive case studies or to be well-referenced research projects. Nursing Standard is looking to publish a series of these as part of our contribution to help nurses and others consider the value of nursing; the first, which deals with an example from Steve Wright's experience, follows his introduction to the series, which sets out his view of why nursing matters.     

The organizational environment and evidence-based nursing

The Province-Wide Nursing Project (PWNP) was designed to remove some of the structural barriers that can impede the ability of nurses in selected health care settings to assess, implement and evaluate best nursing practice. Literature on capacity building and research utilization suggests that the organization is the most important factor in promoting best nursing practice. Therefore, managers and nursing leaders need to encourage the creation of optimum work environments. A survey undertaken by the PWNP Research Centre team assessed the extent to which the 23 agencies in the 4 Participating Complexes provided supportive environments for evidence-based practice. The Characteristics of Agencies in Participating Complexes: Demographics and Resources questionnaire investigated the resources available to help nurses improve their standards of practice in agencies participating in the project. Larger agencies, especially those associated with academic centres, had considerably more resources than agencies in smaller towns. Participation in the Province-Wide Nursing Project enabled agencies to develop strategies to improve the use of evidence in nursing practice.     

Practitioner and organizational barriers to evidence-based practice of physical therapists for people with stroke

BACKGROUND AND PURPOSE: The purpose of this study was to identify practitioner barriers (education, attitudes and beliefs, interest and perceived role, and self-efficacy) and organizational barriers (perceived support and resources) to physical therapists' implementation of evidence-based practice (EBP) for people with stroke. SUBJECTS: The participants were 270 physical therapists providing services to people with stroke in Ontario, Canada. METHODS: A cross-sectional mail survey was conducted. RESULTS: Only half of respondents had learned the foundations of EBP in their academic preparation or received training in searching or appraising research literature. Although 78% agreed that research findings are useful, 55% agreed that a divide exists between research and practice. Almost all respondents were interested in learning EBP skills; however, 50% indicated that physical therapists should not be responsible for conducting literature reviews. Average self-efficacy ratings were between 50% and 80% for searching and appraising the literature and below 50% for critically appraising psychometric properties and understanding statistical analyses. Despite Internet access at work for 80% of respondents, only 8% were given protected work time to search and appraise the literature. DISCUSSION AND CONCLUSION: Lack of education, negative perceptions about research and physical therapists' role in EBP, and low self-efficacy to perform EBP activities represent barriers to implementing EBP for people with stroke that can be addressed through continuing education. Organizational provision of access to Web-based resources is likely insufficient to enhance research use by clinicians.     

Collaborative synergy: practice and academic partnerships in evidence-based practice

In this department, Dr Newhouse highlights hot topics in nursing outcomes, research, and evidence-based practice relevant to the nurse administrator. The goal is to discuss the practical implications for nurse leaders in diverse healthcare settings. Content includes evidence-based projects and decision making, locating measurement tools for quality improvement and safety projects, using outcome measures to evaluate quality, practice implications of administrative research, and exemplars of projects that demonstrate innovative approaches to organizational problems. This column describes potential collaborations in evidence-based practice between clinical settings and colleges or universities.     

Applying evidence-based practice: delirium

Delirium often occurs in older hospitalized inpatients. However, it is frequently not diagnosed or prevented at an early stage. Delirium leads to poor prognoses and prolongs hospitalized days. This article integrates current evidence-based literature to summarize prevention, early assessment and management strategies for delirium. The authors further present a delirium management algorithm. The authors hope this study will provide a reference for healthcare professionals responsible for delirium patient care.     

Scoliosis and evidence-based practice

The relationship between development during the first 2 years of life and similar aspects of development at 4 years of age was investigated. The neuro-sensory motor and general developmental abilities of 124 (62 male and 62 female) low birth weight or mechanically ventilated infants were assessed at 4, 8, 12, 18, 24 and 48 months after the expected date of delivery. Results indicated a positive relationship between development on all occasions >2 years and outcome at 4 years of age. Neuro-sensory motor assessment at 8 months of age was the most valuable in identifying children at risk for difficulties in motor development at 4 years of age. The most accurate prediction of intellectual developmental ability were obtained at 12 and 18 months of age.