Evidence-based practice guidelines and school nursing.

The use of evidence-based practice (EBP) has become the standard of health care practice. Nurses are expected to use best evidence on a wide range of topics, yet most nurses have limited time, resources, and/or skills to access and evaluate the quality of research and evidence needed to practice evidence-based nursing. EBP guidelines allow nurses and other health care workers to have research information collected, analyzed, and condensed into specific practice recommendations by experts. This article defines EBP guidelines and discusses the process of guideline development, including identification of topics, systematic literature searches, and evaluation and rating of research. Criteria for determining the quality of existing guidelines are reviewed. The steps needed to develop EBP guidelines specifically for school nursing are discussed.     

Governing nursing conduct: the rise of evidence-based practice

Drawing on the Foucauldian concept of 'governmentality' to analyse the evidence-based movement in nursing, we argue that it is possible to identify the governance of nursing practice and hence nurses across two distinct axes; that of the political (governance through political and economic means) and the personal (governance of the self through the cultivation of the practices required by nurses to put evidence into practice). The evaluation of nursing work through evidence-based reviews provides detailed information that may enable governments to target and instruct nurses regarding their work in the interest of preserving the health of the population as a whole. Political governance of the nursing population becomes possible through centralised discursive mechanisms, such as evidence-based reviews that present nursing practice as an intelligible field whose elements are connected in a more or less systematic manner. The identity of the evidence-based nurse requires the modern nurse to develop new skills and attitudes. Evidence-based nursing is an emerging technology of government that judges nursing research and knowledge and has the capacity to direct nursing practice at both the political and personal level.     

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.     

Clinical nurse specialists shaping policies and procedures via an evidence-based clinical practice council

In the practice of nursing, organizations with progressive evidence-based practice programs implement structures and processes whereby nurses are engaged in the review of existing research and in the development of clinical practice documents to better align nursing practices with the best available scientific knowledge. At our academic hospital system, clinical nurse specialists (CNSs) took the lead to help transform a traditional nursing policy and procedure committee into a hospital-wide, staff-represented Clinical Practice Council (CPC) that ensures evidence-based nursing practices are reflected in the organization's nursing practice documents for the provision of patient care. Clinical nurse specialists function as mentors and cochairs who are dedicated to ensuring that nursing practice is supported by the latest evidence and committed to guiding staff nurses to continually move their practice forward. The success of the CPC is due to the leadership and commitment of the CNSs. This article describes the structure, process, and outcomes of an effective CPC where CNSs successfully engage frontline clinicians in promoting nursing care that is evidence based. Clinical nurse specialist leadership is increasingly made visible as CNSs effectively involve staff nurses in practice reforms to improve patient outcomes.     

Selecting a model for evidence-based practice changes: a practical approach

Evidence-based practice models have been developed to help nurses move evidence into practice. Use of these models leads to an organized approach to evidence-based practice, prevents incomplete implementation, and can maximize use of nursing time and resources. No one model of evidence-based practice is present that meets the needs of all nursing environments. This article outlines a systematic process that can be used by organizations to select an evidence-based practice model that best meets the needs of their institution.     

Handheld computer software for school nurses.

School nurses used computers in the 1980s, the Internet in the 1990s, and are embracing handheld computers in the first decade of the 21st century to improve their practice. The purpose of this article is to provide information about handheld computers and software applications that school nurses can use in day-to-day, emergency, and disaster situations. Handheld computers help school nurses to make decisions based on accurate and up-to-date information, and to practice evidence-based nursing. Evidence-based nursing is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise, and patient preferences.     

Evidence-based practice in rehabilitation nursing.

How to use research is a learned skill. With this skill rehabilitation nurses can help ensure that their practice is based on the best evidence available. Evidence-based practice is a balance of using external research-based clinical evidence and clinical expertise. The purpose of this article is to show rehabilitation nurses how to build the skills for using evidence, rather than just doing research. This involves asking questions, finding and appraising relevant data, and putting that information into everyday practice. When evidence-based practice is merged into a clinician's daily routine, the result is a more analytical and, ultimately, effective clinical practice.     

Recognizing the evidence and changing practice on injection sites

Evidence-based practice requires the integration of the best available evidence in conjunction with clinical expertise to make decisions about patient care. At times new research and evidence will contradict established or traditional methods and clinical textbooks: this is in the nature of progress, and the challenge lies in disseminating this new evidence throughout the profession as quickly and widely as possible. The nursing literature cites a number of barriers to evidence-based nursing, and notes that the research evidence for clinical practice utilization does not always percolate down to the clinical setting. This article considers the attitudes of nurses to evidence that challenges traditional practice, focusing in particular on conventional and contemporary best practice regarding injection sites. Nurses in clinical practice continue to use and instruct student nurses in the use of the dorsogluteal (the large gluteal muscle in the buttocks) injection site as the site of choice for intramuscular injections, despite abundant evidence regarding the complications associated with using this site. Advancing the use of the ventrogluteal (located in the hip) injection site is a challenge, primarily owing to nurses' lack of familiarity with its anatomical landmarks and the published evidence on its benefits. The authors of this article present the current evidence on the dorsogluteal and ventrogluteal intramuscular injection sites in an attempt to assist nurse decision-making and guarantee the integration of evidence-based knowledge in order to improve patient care.     

Evidence for psychiatric nursing practice: an analysis of three years of published research

Psychiatric and mental health nursing practice continues to be strongly influenced by tradition, unsystematic trial and error, and authority. Yet the need for quality care that is based on the best and most current empirical research is well documented. Achieving evidence-based practice in the psychiatric nursing specialty will require that qualified nurse researchers conduct research relevant for practice and appropriately disseminate that research to those who can best use it, practicing nurses. This State of the Evidence Review analyzed the 227 data-based studies published in the five most commonly read American psychiatric nursing journals from January 2000 through December 2002. Five major research foci were found: global perspectives, psychiatric nurses as subjects, studies of family caregivers, research with clients across the life span, and testing of nursing interventions. About 88% of the studies were conducted in the United States; 63% involved recipients of mental health care services; but only 11% tested psychiatric nursing interventions. Promoting evidence-based practice in psychiatric nursing will require increasing the numbers of psychiatric nurse researchers, enriching the research process (i.e., increasing relevance and appropriate dissemination), and implementing changes in practice that are based on the best and most currently available evidence, rather than on the equivalents of "Old Wives' Tales."     

Building a framework for getting evidence into critical care education and practice.

One challenge for nurse educators is how best to enhance the integration of theory and practice elements in relation to critical care nursing. Practice should be evidence-based, i.e. the best available empirical evidence, including recent research findings, should be applied in practice in order to aid clinical decision-making. Barriers to the implementation of research exist at many levels including the individual practitioner, the clinical team, the practice setting and wider organizational factors. The authors propose that clinical guidelines can provide a vital link between theory and practice. At varying levels the use of care protocols, clinical pathways and algorithmic guidelines (provided they are rigorously reviewed and evidence-based) can help infuse research into practice, thereby promoting quality and standardization of care. The purpose of this paper is to discuss the value and use of these frameworks in promoting and raising awareness of the need for and use of evidence-based approaches to critical care education and practice. In this paper, we present outline information relating to an assessment method, adopted for continuing education courses in critical care within our department. This approach is designed to combine the best available evidence with reflective practice through the assessment process.     

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.     

Clinical coaching: a strategy for enhancing evidence-based nursing practice

PURPOSE: The purpose of this article is to describe how clinical nurse specialists can promote the development of knowledge and skills in nurses as one step toward making evidence-based nursing practice the norm in all patient care settings. BACKGROUND: The need for the use of evidence in nursing practice has been highlighted for several decades. Moving evidence more quickly into practice requires that nursing use many strategies. DESCRIPTION OF STRATEGY: The strategy of clinical coaching is proposed in this article for the development of skills in nurses specifically to promote evidence-based nursing practice. Clinical coaching is a relationship for the purpose of building skills. This strategy is aimed at increasing foundational staff nurse knowledge and skills. CONCLUSION: The achievement and maintenance of evidence-based nursing practice take continuous attention from clinical nurse specialists. Clinical coaching is only one part of a comprehensive approach for establishing and sustaining evidence-based nursing practice.     

Evidence-based practice and nursing: commentary

With changes in health care, it has become clear that nurses need data to establish evidence for their decisions and interventions. Evidence-based practice involves the use of the best evidence available for making clinical decisions about patient care. The identification of the knowledge base for nursing practice contributes to achieving patient outcomes and making nursing practice credible.     

Translating research on venous thromboembolism into practice

EVIDENCE-BASED NURSING PRACTICE incorporates the best research available with clinical expertise. It can be difficult, however, for nurses to integrate use of evidence into their everyday work.THIS ARTICLE PROVIDES an example of using research findings to implement best nursing practice for patients at risk for venous thromboembolism (VTE). Remaining current on methods to prevent and treat VTE is essential for nurses throughout the hospital but is especially important in the perioperative environment.NURSES CAN USE THIS EXAMPLE as a basis for establishing evidence-based practice in other patient care situations.     

Clinical nurse educators as agents for change: increasing research utilization

The purpose of this study was to examine the determinants of research utilization among clinical nurse educators. The primary goal for clinical nurse educators is the facilitation of professional development of practicing nurses. Responsibilities include promoting best practice by mentoring others, acting as an information source, and assisting in the development of policies and procedures based on available research evidence. Using Rogers’ (Diffusion of Innovations, 4th edn., The Free Press, New York) diffusion of innovations theory as a theoretical foundation, we conducted a secondary analysis to test a predictive model of research utilization using linear regression. Results show that educators report significantly higher research use than staff nurses and managers. Predictors of research utilization include attitude toward research, awareness of information based on research, and involvement in research activities. Localite communication predicted conceptual research use and mass media predicted symbolic use, lending support to the idea that overall, instrumental, conceptual, and symbolic research utilization are conceptually different from one another. Our findings show that the research utilization behaviors of clinical nurse educators position them to facilitate evidence-based nursing practice in organizations. We discuss the theoretical, conceptual, and nursing role implications of our findings for nursing practice, education, and research. Suggestions for future research includes studying actual use of research findings of clinical nurse educators and designing intervention studies that assesses the effectiveness of clinical nurse educators as facilitators of research utilization in organizations.     

Tensions and contradictions in nurses' perspectives of evidence-based practice

Aim  To explore nurses' understanding and interpretation of evidence-based practice (EBP).
Background  EBP has been welcomed into the nursing lexicon without a critical examination of its interpretation by practitioners. The literature suggests that there is a great deal of confusion and contradiction over the meaning and application of EBP. Although work has been conducted on how EBP might be implemented, the general issue of how nurses understand and use EBP is largely unexplored. This paper seeks to examine in depth the understandings of EBP, to enable managers, educationalists and policy makers to implement it more effectively.
Methods  All registered nurses, midwives and health visitors in one UK National Health Service (NHS) Trust were asked to complete a questionnaire in October 2006.
Results  Despite a disappointing response rate (8.9%, 218/2438), the survey revealed interesting tensions and contradictions in nurses' understanding of EBP. National and local guidelines, practitioners' own experience and patients' preferences were the main influences on nurses' practice. Published research had relatively little impact, particularly among nurses graded E, F and G and those who had not attended a study day on EBP.
Conclusions  The hierarchies of evidence propounded in local and national guidelines are not adopted by practising nurses, who use other sources of evidence, such as reflection on their own experiences, when making clinical decisions. However, subsuming published evidence to clinical judgement does not contradict the original tenets of EBP.
Implications for Nursing Management  Unless it is incorporated into national or local guidelines, research has relatively little impact on practice. To develop nursing practice and nursing knowledge, nurse leaders need to foster the synthesis of experiential knowledge and published research, in accordance with the founding principles of the EBP movement.     

Introducing evidence into nursing practice: using the IOWA model

Evidence-based practice has gained increasing popularity in all healthcare settings. Nurses are urged to use up-to-date research evidence to ensure better patient outcomes and inform decisions, actions and interactions with patients, to deliver the best possible care. Within the practice setting, there is an increasing challenge to provide clearly measurable care of the highest quality, which is evidence-based. In order for nurses to operate from an evidence-based perspective, they need to be aware of how to introduce, develop and evaluate evidence-based practice. This article presents how evidence may be introduced into practice using the Iowa model, offering practical advice and explanation of the issues concerning nurses in practice.     

Practice makes perfect: tips for successful institutional review board submissions

As the nursing profession seeks to develop evidence-based practice, nurses are being encouraged to embark on research in their institutions. Staff nurses and nurse clinicians often struggle with the process of obtaining institutional review board approval for their projects. When classes are available, the focus is frequently on informing nurses about the federal regulations for protection of human subjects. This article addresses practical strategies for addressing these regulations from the perspective of both the individual nurse and the nursing leader.     

Where's the evidence? An innovative approach to teaching staff about evidence-based practice.

Preparing nurses to incorporate research and evidence-based findings into nursing practice is important to meet the needs of patients and their families in today's healthcare arena. This article highlights the use of a mock trial as an innovative approach to educating staff nurses on evidence-based practice and identifies future implications for educating staff nurses on incorporating evidence into nursing practice.