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68 ReferencesEvidence-based practice: A practical approach to implementation
Abstract
Organizations often do not have processes in place to support nurses through a systematic approach for developing and evaluating nursing interventions, protocols, critical pathways, and policies that are derived from scientific evidence. The development of a framework to guide inquiry will have a positive impact on patients. This process may foster a higher level of professional engagement by nurses that may, in the long-term, help improve nurse retention and recruitment. The authors discuss a nursing evidence-based practice model and guidelines that were developed by a team of hospital and academic nurse leaders and is practical and easy to use. This model has been successfully implemented across the department of nursing as a strategic initiative. Results of the implementation have shown that staff nurses can effectively use this model with the help of knowledgeable mentors.
- CitationsCitations71
- ReferencesReferences68
- Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence, including research results, expert opinion, in conjunction with patient preference to guide health care decisions [2]. EBP guidelines were applied to clinical practice, not only the nurses' knowledge and skills show improvement, but patients' satisfaction with nursing services also showed an increase and the patients showed rapid recovery from their illnesses [3]. Evidence-based practice are developed by identifying, evaluating, and integrating a variety of evidence in a form that medical personnel can use to apply research easily to clinical practice [4].
[Show abstract] [Hide abstract] ABSTRACT: This study developed smartphone application evidence-based practice education program evaluated the usability this application. system was using four processes: analysis, design, development, testing. consists modules covering content, quiz, guideline recommendations postoperative management, tools evaluating user satisfaction with system. First, Java SE Development Kit (JDK) 7 installed, followed by Android SDK 4.1.2. main page has seven sections: environmental settings, member administration, learning quiz statistical settings. overall level 3.75, mean score question 'Do you think application-evidence guidelines is necessary?' 3.92. frequency use 47.25 times. can be used via nurses, would easily accordance clinical setting.- In addition, discovery and development of evidence that can be applied to match the needs of each patient by individual nurses in their practice is not easy. According to previous studies, when EBP guidelines were applied to clinical practice, not only did the nurses' knowledge and skills show improvement, but patients' satisfaction with nursing services also showed an increase and the patients showed rapid recovery from their illnesses (Specht; Newhouse, Dearholt, Poe, Pugh, & White, 2005). However, in paper format, the EBP guidelines contain many algorithms that are not easily accessible whenever nurses need them, making their application to clinical practice difficult (Doebbeling, Chou & Tierney, 2006; Jha et al., 2006).
[Show abstract] [Hide abstract] ABSTRACT: Purpose The purpose of this study was to develop evidence-based guidelines on postoperative pain management via the web and to examine the effects in terms of pain level of patients undergoing abdominal surgery and nurses’ knowledge of postoperative pain management. Methods First, evidence-based pain guidelines were developed via the web in a tertiary hospital. Second, a special educational program on evidence-based pain guidelines for nurses was developed after validation of content by experts. Third, diverse strategies were adopted in order to facilitate incorporation of evidence-based pain guidelines in practice. Fourth, nurses in the study units were educated on evidence-based guidelines using the developed educational program for 3 weeks before their implementation of evidence-based pain guidelines to patients. Patients were assigned to the control group (from July 29 to August 20, 2011) and the experimental group (from September 24 to October 25, 2011) according to interrupted time interval. The data were analyzed using chi-square test, analysis of variance test with Scheffé’s test as a post hoc and repeated measure of analysis of variance. Results Patients in the experimental group showed a significantly lower level of pain. Nurses’ knowledge of management of postoperative pain showed a significant increase after installation of evidence-based guidelines. Conclusion Evidence-based pain guidelines were effective in reducing the pain level of patients as well as improving nurses’ knowledge of pain management.- These programs are sometimes adopted as a national policy [12, 29] . As it is the responsibility of both nurse researchers and nurse practitioners to ensure research utilization, hospitaluniversity collaboration projects are especially crucial for eliminating barriers regarding the use of evidence in nursing management decisions [30, 31] . These cooperatively conducted studies will also facilitate building an evidence-based organizational culture.
- Evidence-based practice is a sensible, easily applied method of practice improvement that can be led by nurses (Dontje, 2007). Evidence-based practices combine research evidence with clinical expertise and patient values to execute sound interventions that advance nursing practice, patient education and health outcomes (DiCenso, Guyatt, & Ciliska, 2005; Newhouse, Dearholt, Poe, Pugh, & White, 2005; Wallace, Shorten, & Russell, 1997). Th e skillful application of evidence-based practice requires a nurse to access current research, interpret fi ndings and place these results in the context of a care situation (Haynes, Devereaux, & Guyatt, 2002 ).
[Show abstract] [Hide abstract] ABSTRACT: Prolonged skin-to-skin contact (SSC) between mothers and newborns in the hour after birth is associated with physiologic and psychological benefits for both mothers and infants, yet this is not a standard practice at all birthing facilities. The purpose of the project described in this article was to implement SSC immediately aft er birth for healthy term newborns as a routine, evidence-based practice in a labor and delivery unit at a Midwestern U.S. academic medical center. When incorporated into routine newborn care, SSC promotes key maternal-infant health outcomes of importance to quality nursing care.- Faculty members at Johns Hopkins University use the model to teach EBP and critical thinking, and nurses at the Johns Hopkins Hospital have adopted the model as their standard for EBP. Nurses using the model understand the basis for their current nursing interventions and also understand how to change practice based on new evidence (Newhouse et al. 2005; 2007). In summary, there are many models/frameworks that nurse leaders can choose to help guide and transform their organization to integrate EBP.
[Show abstract] [Hide abstract] ABSTRACT: Background: Evidence-based practice (EBP) models provide a framework to guide organizations and their clinicians to implement evidence-based policies, protocols, and guidelines. A historical review of evidence-based models is presented. The revised Colorado Patient-Centered Interprofessional EBP Model supports use of research evidence and nonresearch evidence and adopts a patient-centered approach to EBP. Aim: The purpose of this article is to present a framework that can be used to transform an organization and foster the use of evidence by interdisciplinary team members. Approach: An evidence-based intervention to decrease catheter associated urinary tract infections (CAUTI) is presented to show how the model is operationalized. The EBP model is supported by the five steps that clinicians should use as they identify a clinical problem, gather the evidence, and move the evidence into practice. Ideas for dissemination of new models to clinicians throughout the organization are presented.- Multi-faceted training that includes lecture-based information, instructional videos or demonstration of new practices, practical examples, and opportunities for practice with behavioral response are significantly more effective in successfully implementing a change in practice (Torrey et al., 2001; Dixon et al., 1999: Torrey, Lynde, Gormal, 2005). Additionally, any new model should be designed to be implemented in a step-wise fashion (Torrey et al., 2005;), so that practitioners are able to practice one new method at a time rather than trying to effectively implement all new practices simultaneously (Newhouse, Dearholt, Poe, Pugh, White, 2005). A Train the Trainer approach to dissemination potentially has several advantages, including building in a structure for sustainability, adaptability, and relationship building (Orfaly, et al. 2005).
[Show abstract] [Hide abstract] ABSTRACT: Evidence-based practices to improve outcomes for children with severe behavioral and emotional problems have received a great deal of attention in children's mental health. Therapeutic Foster Care (TFC), a residential intervention for youth with emotional or behavioral problems, is one of the few community-based programs that is considered to be evidence-based. However, as for most treatment approaches, the vast majority of existing programs do not deliver the evidence-based version. In an attempt to fill this gap and improve practice across a wide range of TFC agencies, we developed an enhanced model of TFC based on input from both practice and research. It includes elements associated with improved outcomes for youth in "usual care" TFC agencies as well as key elements from Chamberlain's evidence-based model. The current manuscript describes this "hybrid" intervention - Together Facing the Challenge - and discusses key issues in implementation. We describe the sample and settings, highlight key implementation strategies, and provide "lessons learned" to help guide others who may wish to change practice in existing agencies.
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Indiana University-Purdue University Columbus
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