Implementing Evidence-Based Nursing Practice

Teri Britt Pipe; Kay E. Wellik; Vicki L. Buchda; Carol M. Hansen; Dana R. Martyn

Disclosures

Urol Nurs. 2005;25(5):365-370. 

In This Article

Conceptual Model for Translating Evidence Into Clinical Practice

Rosswurm and Larrabee (1999) proposed a model for guiding nurses through a systematic process for the change to evidence-based practice (see Figure 1). This model recognized that translation of research into practice requires a solid grounding in change theory, principles of research utilization, and use of standardized nomenclature. The model has the following six phases:

A Model for Evidence-Based Practice

  • Assess the need for change in practice.

  • Link the problem with interventions and outcomes.

  • Synthesize the best evidence.

  • Design a change in practice.

  • Implement and evaluate the practice.

  • Integrate and maintain the practice change.

The model provides a pragmatic, theory-driven framework for empowering clinicians in the process of evidence-based practice.

The Rosswurm and Larrabee conceptual framework (1999) was used to adapt the existing medical evidence-based practice conferences to an approach that incorporated a focus on nursing phenomena with the goal of teaching nurses the EBNP model, while also evaluating the possibility of changing clinical practice. The application of the model is as follows:

  1. Assess the Need for Change in Practice. Is there evidence to support the use of an early warning scoring system and communication triggers to guide nurses in clinical decision making in the medical setting? The issue came to the NPS as part of an examination of current practice. Stakeholders were involved intentionally by asking a staff nurse (who serves as team leader) and a CNS to lead the literature search.

  2. Link the problem, Interventions, and Outcomes. Standardized nursing classification systems and nomenclature were used to identify the problem, and the desired outcomes of recognition of early warning signs and prevention of clinical deterioration in medical-surgical patients.

  3. Synthesize the Best Evidence. The director of library services used a systematic, organized strategy to guide the nursing literature search using the Cumulative Index to Nursing and Allied Health Literature (CINAHL) database. The team read and critically reviewed the literature, and weighed the evidence in conjunction with the clinical nurse researcher.

  4. Design Practice Change. A roundtable Discussion was conducted at the EBNP conference, followed by several other focused discussions about practice changes. Several strategies were identified to explore the original issue further and to implement it into practice. For instance, programs have been implemented educating and mentoring nurses in strategies of detecting early warning signs and communicating these effectively to other members of the health care team.

  5. Implement and Evaluate the Change in Practice. Currently, the evidence does not support changing practice, but rather building and fortifying systems of knowing the patient, identifying problems early, and communicating and managing changes in patient status in a timely manner.

  6. Integrate and Maintain the Change in Practice. This step of the model is pending further evaluation and consideration. As a start, the article by Minick and Harvey (2003) and information from the conference have been included in the Advanced Preceptor Workshop.

The nursing evidence-based practice conference had the following objectives, which were adapted from the original medically focused program:

  1. Develop knowledge and skills in assembling critically appraised topics based on relevant clinical nursing questions.

  2. Recognize knowledge gaps and articulate well-formulated, answerable clinical questions.

  3. Search and evaluate the nursing and health sciences literature with guidance and in collaboration with library sciences. An initial review of the citations retrieved indicated a variety of indexing terms of potential interest. The original combination of "medical-surgical nursing" and "decision making, clinical" yielded more than 400 articles. These were narrowed using other key indexing terms. Finally, approximately 20 articles were reviewed and one exemplar article was chosen to represent the state of current literature on the topic.

  4. Present evidence-based conclusions with applications to nursing practice.

  5. Use group Discussion as a vehicle for education on the EBNP process and for organizational learning.

  6. Develop a culture to allow self-perpetuation of the EBNP seminar.

    • Progress learners (staff nurses and CNSs) into facilitators (teachers).

    • Promote continuous self-directed learning as a professional value.

    • Establish a library of electronic and paper EBNP resources.

    • Promote the concept of using best evidence in daily clinical practice.

    • Study and overcome gaps between research and practice.

    • Improve use of informatics and library resources by staff nurses.

    • Encourage clinician use of published critically appraised topics (products of the curriculum).

    • Encourage study of changes in clinician practice patterns.

The strategy to accomplish these objectives was planned by representatives from nursing administration, research, and practice, with input from nursing education. The conference was implemented by designing educational sessions in which a staff nurse teamed with a CNS based on self-expressed interest in the topic, and the director of library services helped to search and review the relevant literature. One article was chosen as an exemplar and reviewed in further detail. The article and critique guidelines were distributed electronically to nurses (Minick & Harvey, 2003). Next, the staff nurse and CNS consulted with the clinical nurse researcher to weigh the evidence and to discuss the research methodology used. Team members described their search and the findings in a 1-hour conference, with continuing education credit awarded. The nurse researcher presented a short Discussion on the research methodology used in the article. A small group Discussion (30 to 40 attendees) format was used to critique the article and to provide feedback on the clinical usefulness of the findings. The chair of the NPS described how the specific evidence presented in the conference pertained to institutional practice.

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