Caring-Healing Inquiry for Holistic Nursing Practice: Model for Research and Evidence-Based Practice

Karen Dorn, RN, PhD, APRN-BC

Disclosures

Topics in Advanced Practice Nursing eJournal. 2004;4(4) 

In This Article

Leadership

Developing a research program and creating a culture of EBP in the clinical setting require leadership and organizational support.[4] Leadership requires elements, such as a chief nursing officer committed to the endeavor, an in-house research leader, a research committee, and advanced practice nurses, committed to research and EBP.[5] In addition, setting expectations that nurses participate in research is the key to success, and such expectations need to be supported through staff development, mentoring, and the opportunity for career advancement.[5]

The chief nursing officer at Avera McKennan, recognizing the value of research and the use of evidence in enhancing nursing practice, has a vision to make nursing research meaningful and accessible to the bedside caregiver. In this vision, primary ownership of the research program lies with the nurses directly involved with patient care, as illustrated in Figure 1. The intent is that nurses directly involved in patient care, including advanced practice nurses and staff nurses, routinely engage in systematic inquiry of practice through research and EBP, thereby having the greatest influence on research efforts and program success.

Figure 1.

Leaders in research: developing ownership of direct care nurses (CNO = chief nursing officer).

To provide in-house research expertise to guide program development, the chief nursing executive, in collaboration with the chair of a neighboring school of nursing, negotiated a joint appointment position between the hospital and the college, creating the Avera McKennan Nursing Professorship at Augustana College. The College, a liberal arts institution with graduate and undergraduate programs in nursing, shares common values and is rooted in a Christian faith tradition, as is the hospital (Lutheran and Roman Catholic, respectively).

This education-practice partnership creates a win-win situation for both organizations. The hospital receives research expertise and consultation, whereas faculty and students have a greater opportunity for involvement in clinical research. In this collaborative arrangement, the nurse-researcher enhances and promotes an effective clinical research program and contributes to staff development in the areas of research and clinical innovation. At the college, the faculty member provides leadership in curriculum development and expertise in clinical practice and teaching. Additionally, the hospital provides a research budget for program development and the college offers tuition reduction for hospital personnel.

A nursing research committee, composed largely of advanced practice nurses, provides ongoing leadership for program development and implementation. At the onset of this initiative, the research committee shifted from its primary activity of reviewing research proposals to serving as an advisory group for strategic program planning and development. The name of the committee is now the Nursing Research Steering Committee (NRSC), reflecting its expanded role in establishing goals for the research program, generating ideas for research and evidence-based practice projects, and establishing research priorities. The nurse-researcher facilitates the work of the committee and provides continuity. Advanced practice nurses (collectively representing nursing administration, nursing education, and nursing practice) play a crucial role on the committee. Their knowledge of the organization, the organizational climate, and practice issues is essential for the successful implementation of program activities. The committee also relies on the contributions of nurses in both clinical and quality-improvement roles.

Much of the planning and decision making within nursing service occurs at the nurse governance level of the hospital. The nurse-researcher and the NRSC regularly seek input and endorsement from the councils on program development. This ensures that the research program will have "grass roots" support and be relevant and meaningful to nurses throughout the organization. The governance councils also serve as a means for reporting progress and disseminating work on the research program as it evolves. The 3 nurse governance councils are the nurse executive council, nurse manager council, and nurse governance council, including senior nurse leaders and directors, unit managers, and staff nurses, respectively.

Based on the work of many leaders within the organization, the following goals have been established for the research programs:

  • Develop, implement, and evaluate a theory-based model to guide nursing research;

  • Conduct clinical research and promote evidence-based practice;

  • Develop programmatic priorities in areas of excellence and expertise;

  • Provide staff development and mentoring for nurses and nursing students;

  • Disseminate findings and outcomes of the program; and

  • Support innovation and outreach within the health system and nursing community.

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