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Application of Evidence-Based Research in Nursing PracticeBy Martha Schmidt

“Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe (Institute of Medicine, 2013, iii)

Essential Questions

· What does evidence-based practice mean?

· What is a nurse’s role in using research?

· How does a nurse become knowledgeable about nursing research and evidence-based practice in a particular specialty area?

Introduction

Studies show that registered nurses (RNs) from around the world cite three common barriers to research and implementation of  evidence-based practice (EBP) :

· insufficient time on the job to implement new ideas,

· not enough authority to change patient care procedures, and

· insufficient time to read research (Zhou et al., 2015; Tan, Akgün Sahin, & Kardas Özdemir, 2012; Athanasakis, 2013; Funk, Champagne, Wiese, & Tornquist, 1991).

Keeping abreast of new medical and nursing research is a difficult task. Reading the number of applicable publications, finding time to read them, and evaluating the studies are all factors that contribute to the lack of adoption of new practices. “On average, approximately 75 clinical trials and a dozen systematic reviews are published daily” (Institute of Medicine [IOM], 2013, p. 78). New knowledge is increasing so rapidly that an individual clinician would not have time to read and manage information relative to his or her area of practice (IOM, 2013). Not everyone feels comfortable evaluating the information and bringing it to their health care team for discussion. The novice nurse and the nurse who has not been exposed to research might have difficulty in evaluating research. Fostering a culture of EBP helps to mitigate this issue and encourage the integration of best practices for quality patient care. Evaluating patient outcomes and research helps the RN ensure that the most up-to-date, evidence-based method of care is being used. One of the ways to maintain knowledge of EBP is to read, review, and evaluate published research and care guidelines, particularly in one’s primary field. An easy way to do this is to belong to an organization that delivers monthly newsletters with these guidelines included. Online or print journals are also available through organizations that contain published research. Continual knowledge maintenance will contribute to quality patient outcomes. Patients trust nurses to know the best way to care for them. This research-based body of nursing knowledge changes often, and it is important to continue  lifelong learning .

This chapter will review the format for developing a PICOT statement for translational research questions, examine models that provide processes to develop a practice change innovation, and discuss the future of nursing.

The PICOT Statement

Formulating a clear question is the first step in clinical inquiry. Utilizing the  PICOT statement  develops the clinical question in a systematic, consistent manner. The acronym PICOT stands for:

· Patient/Population

· Intervention

· Comparison

· Outcome(s)

· Time

PICOT is an acronym for the elements of the clinical question: patient population (P), intervention or issue of interest (I), comparison intervention or issue of interest (C), outcome(s) of interest (O), and time it takes for the intervention to achieve the outcome(s) (T). (Stillwell, Fineout-Overholt, Mazurek Melnyk, & Williamson, 2010, p. 59)

All these components need to be concise. For example, when identifying a population, such as adult hospitalized patients, the description needs to specify whether the population is young adults or older adults, as there can be a significant difference between these groups. The intervention is what is to be tested, and the comparison could be to the current, standard procedure. Outcomes of interest is what will be measured, and time will include the time frame of the intervention or study.

Case Study

While working in acute medical/surgical unit, Sam, an RN, notices an increase in the number of patients in the 85 and older age range. Concerned about this population’s safety in returning home, Sam feels that it is critical to begin discharge planning on the patient’s first day in the hospital and that family members must be included. Currently, discharge planning occurs only one day before anticipated discharge. Sam develops the following PICOT question:

P: Among the acute care hospitalized patients 85 years old and older,

I: will early discharge planning,

C: compared to the current method,

O: identify and improve safety measures

T: measured through the first week following discharge?

Check for Understanding

While working on a cardiac unit, an RN recognizes that congestive heart failure (CHF) patients often had not been taking their medications as prescribed before they were admitted to the hospital in acute failure. In this patient population, medications are adjusted frequently, and typically, there are a number of them. In an effort to improve outcomes and reduce acute heart failure episodes, the nurse wonders if one major problem is a lack of sufficient education regarding medications throughout the hospitalization instead of just prior to discharge.

Identify the concepts to include, and develop a PICOT question for this scenario.

P	Among
I	how does
C	compared with
O	affect
T	within

Models Translating Research into Practice

The use of models gives nurses step-by-step processes to organize a change from a problem to a practice for a nursing unit or organization. Topics can be identified as either a problem focus that is derived from risk management, financial, or clinical problems; population outcome; or an educational focus to engage in new research or new practice guidelines. “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” (Doody & Doody, 2011, p. 661). Two models will be reviewed: the Iowa EBP model and the ace-star model of knowledge transformation.

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Topic Examples

Patient falls is an example of a problem-focus topic derived from risk management. Safety issues for patients are essential to study for all situations, whether in a facility or in a community setting, to reduce injuries to patients. Falls in the hospital setting are studied, and many attempts at prevention have been added to nursing practice. For example, some facilites use yellow socks and armbands to identify those at higher risk of falling; hourly rounding by staff has been integrated to help with patient cares, reducing the patient’s need to get up alone; and bed and chair alarms are used. Because falls still occur, further studies are needed to introduce more EBP in fall prevention.

An example of a population-outcome topic is the higher readmission rate of CHF patients. A more structured discharge program could be developed to remedy this occurrence.

Iowa Evidence-Based Practice Model

The Iowa EBP model to promote quality care was developed in 2001 (Titler et al., 2001). Figure 5.1 shows the revised model from 2015. As seen from Step 1, the issues or opportunities, called  triggers, come from various sources. Clinical- or patient-identified issues, new evidence from research, accrediting agency requirements, or philosophy of care are just some of the broad issues that can be identified.  “It is a way for staff nurses to become involved in change and regain ownership of their practice” (Reavy and Tavernier, 2008, p. 166).One important source of change that is often implemented from senior management is government regulations. The “never events” that were mandated by the Centers for Medicare and Medicaid Services (CMS) in 2008, such as patient falls and hospital acquired pressure ulcers, are good examples. Costs to care for the treatment of these events will not be reimbursed to facilities. These examples are not just clinically focused, but also are reflections of risk and financial problems. It is important that RNs have the opportunity for input into the implementation process, rather than be mandated. When adults are told of a new strategy, they need to know why. Implementation is far improved when staff understand, believe in, and support the policies. Reavy and Tavernier (2008) stated “it is a way for staff nurses to become involved in change and regain ownership of their practice” (p. 166).

Using the PICOT statement format, Step 2 of the model states the question, providing a concise, measurable statement. Because there are many competing needs for health care dollars and resources, Step 3 indicates that the researcher should consider whether this topic is an effective use of funds and staff energy. Step 4 is the formation of interdisciplinary teams that include management, staff RNs, and other department members based on the issue to be examined. These team members may also include representatives from staff education, case management, pharmacy, and physical therapy, as a few examples. The team members can assemble, appraise, and synthesize the research available by conducting a systematic search and  evidence synthesis , which is Step 5. Diane Cope (2014), discussed utilizing multiple search engines such as those located in Grand Canyon University’s library database. Step 6 directs the team to determine whether there is sufficient research on the topic and conduct additional research if evidence is lacking.

Step 7 seeks to pilot the practice change in a specific health care setting to evaluate the outcomes and costs as well as uncover other issues that may be barriers to the project prior to starting an organization-wide change. Step 8 directs team members to consider whether the practice change is appropriate or whether they need to consider alternatives. Once the team members approve the change, Step 9 outlines how implementing and sustaining the change becomes important. Overcoming resistance to change and making the change a habit within the group requires education, support, and vigilance. Jordan, Bowers, and Morton (2016) developed a quantitative research study to identify barriers to change at the individual and organizational levels. They stated, “Nurse managers and other stakeholders in healthcare institutions should be aware of these individual and organizational barriers that might hamper the implementation of EBP” (Jordan, Bowers, & Morton, 2016, para. 5). Super users or champions are often identified and educated to support the staff and maintain the change. Often the champion is a nursing staff member who is participating in the team. Finally, Step 10 is dissemination of the study’s results to the nursing community through publishing in nursing journals, speaking to nursing groups, or providing poster session information.

Figure 5.1

The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Health Care

Note. Reprinted with permission from “The Iowa Model of Evidence-Based Practice to Promote Quality Care,” by M. G. Titler, C. Kleiber, V. J. Steelman, B. A. Rakel, G. Burdreau, L. Q. Everett, K. C. Buckwalter, T. Tripp-Reimer, & C. J. Goode, 2001,  Critical Care Nursing Clinics of North America, 13(4), p. 497-509. Copyright 1998 by the University of Iowa Hospitals and Clinics.

Academic Center for Evidence-Based Practice (ACE) Star Model of Knowledge Transformation

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Another important model for organization to translate research into practice is the Academic Center for Evidence-Based Practice’s (ACE) star model of knowledge transformation, developed at the University of Texas Health Science Center in San Antonio (see Figure 5.2). Formerly known as the Star Model, it was renamed the Stevens Star Model of Knowledge Transformation in 2015. Each point of the star guides the organization of the EBP processes and approach.

Figure 5.2

Stevens Star Model of Knowledge Transformation

Note. Reprinted with permission from “Star Model,” by K. R. Stevens, 2012, Academic Center for Evidence-Based Practice. Copyright 2012 by the University of Texas Health Science Center at San Antonio.

The first point of the star is discovery research, or discovery of current knowledge and new knowledge developed by traditional research. This begins with the question or issue that the staff has identified as important to their practice. Again, developing the concise PICOT statement or question helps to clarify what is to be discovered. Evidence summary, Point 2, is a concise compilation of the research studies on the subject. This part of evidence synthesis gives information on what is known and where there are gaps in the knowledge. The Cochrane database search is an effective first method to obtain large quantities of information in a useful format. It will include research that has been done on the particular subject. Further searching for more current studies and reviewing them for  validity  and  reliability  is important for this stage of the process. Translation is the third point on the star. Here, the evidence summary is combined with clinical expertise, which is often termed  clinical practice guidelines (CPGs) . CPGs are also known as care pathways, protocols, or care standards. One example of CPGs are the recommendations for healthy weight-control education found in the National Guideline Clearinghouse (NGC). Point 4 of the model is practice integration or implementation. At this stage, the individuals and the organization adopt the changes through formal and informal methods. Point 5 is evaluation, which is vital for measuring success. Evaluation may include patient outcomes, nursing provider outcomes, and systemic outcomes. (Stevens, 2012). Examples of evaluation would be in the discussion section the research study. It is an interpretation of the results of the implementation and how the results can be used to fit the practice.

RNs utilize models, such as the nursing process, constantly and are important to critical systematic thinking. In everyday practice, when issues are identified, the existing models can be integrated to guide RNs to identify and plan changes carefully, as they are important guidelines for improving EBP.

Clinical-Based Project Planning

Both models outline project development that includes evidence, safe care, improved outcomes, and an interdisciplinary team.  “Two concepts central to the issue of using evidence-based practice are ownership of a problem and involvement with the process to solve the problem” (Reavy & Tavernier, 2008, p. 167).Sometimes the project may be due to patient errors identified by risk management or a new update to a standard of care. At times, ideas and recommendations flow from the unit/clinic level via unit/clinic representatives to the councils empowered to act on these issues, particularly when Magnet status has been earned by the facility (Cleveland Clinic, 2015). Quality and risk management, unit representatives, other staff RNs, master’s prepared nurse educators, unit managers, and other disciplines such as pharmacists, doctors, nurse practitioners, and laboratory personnel are important to this team approach. Staff RNs are essential to the group processes. “Two concepts central to the issue of using evidence-based practice are ownership of a problem and involvement with the process to solve the problem” (Reavy & Tavernier, 2008, p. 167).

Involving Leadership

This section focuses on removing barriers to evidence-based interventions, particularly as it pertains to health care agencies and administrators. Even though there is consumer pressure, government reports, and support from health care leaders, such as the American Nurses Association (ANA), there are still inconsistencies in the in the integration of EBP into clinical practice (Yackel, Short, Lewis, Breckenridge-Sproat, & Turner, 2013).

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Friesen, Brady, Milligan, & Christensen (2017) identified that “organizational leadership

support is key to the successful implementation of EBP” (p. 22). Continued support of innovations through “a budgetary commitment to human and logistical resources is foundational to bringing an innovation across a hospital system” (Friesen et al., 2017, p. 22). Leadership must support the components necessary to create a successful EBP implementation. These components include time for the nurse to be away from the bedside for collaboration, research, and implementation. Providing nurse researchers who can teach, be a role model, and support the staff in these projects is also critical. The nurse researcher can also be aware of and resolve the barriers to staff nurses’ participation in research and implementation. Master’s prepared RNs on staff to guide the projects as the time, budget, and support from educationally prepared RNs is essential for success.

Partnerships with universities or health care systems is a valuable route to pursue. Such partnerships provide BSN students the opportunity to learn aspects of nursing research by participation in the stages of research. Enthusiasm for research can be enhanced by real-world participation. The health care system could also benefit by having the students do literature searches or data collection, saving staff time and money.

Comparing Quality Improvement, EBP, and Research

Quality improvement, EBP, and research are often overlapping terms that are not clearly identified. Table 5.2 indicates the difference between quality improvement (QI), EBP, and research. This overlap can make it a challenge for RNs to investigate clinical problems.

Table 5.2

The Difference Between QI, EBP, and Research

Concept	Purpose	Considerations	Example
Quality Improvement	Improve processes or efficiencies, reduce variations in care, address administrative or educational problems	Institutional data, health policy data, and review of the literature pertaining to the quality improvement initiative are needed in order to implement a quality improvement initiative in any clinical setting.	Assessing the need for and implementing urinary catheter protocols for insertion and timely removal with a goal of reducing catheter-associated urinary tract infections
Evidence-Based Practice	Process to integrate the best research evidence with patient values and clinical expertise	Process includes PICOT; finding the best evidence through extensive literature reviews, applying the evidence to practice, and evaluating outcomes	Implementing a new evidence-based clinical practice guideline at an institution, such as prevention of ventilator-associated pneumonia
Research	If gaps in a literature review are identified, a study generates new knowledge or validates existing study to answer specific research question	Human subject approval is needed through the institution and protection for the subjects is required through informed consent and/or protection of privacy; research methods are implemented	A randomized controlled trial of two skin antimicrobials for central line care to prevent infection

Note. Adapted from “The Difference Between Quality Improvement, Evidence-Based Practice, and Research,” by P. K. Ginex, 2017, ONS Voice. Copyright 2017 by the Oncology Nursing Society.

QI often addresses an issue identified by lower than expected outcomes. For example, a patient presents to the emergency department with symptoms of pneumonia. A QI initiative would ensure that the patient receives appropriate, timely, documented treatment. These might include chest X-ray, blood culture prior to starting antibiotics, and administering appropriate antibiotic within 2 hours of admission. EBP initiatives would search existing research literature, use a model for development, and implement and sustain the best research evidence with patient values and clinical expertise. An example of EBP is implementing a new evidence-based clinical practice guideline at an institution, such as prevention of ventilator-associated pneumonia. Research involves identifying the gaps in current research literature and developing a study to generate new knowledge or validate an existing study. Human research approval is required, as well as informed consent. An example of research is randomized controlled trial testing two skin antimicrobials for central line care to prevent infection.

The goal of answering clinical questions is to improve patient outcomes. Each of these methods of asking and answering focused clinical questions are important and each are good methods to improve clinical outcomes. (Ginex, 2017)

Culture of Advocacy

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Research implementation and innovation of EBP are applicable in all areas of nursing, hospitals, clinics, rehabilitation, case management, home health, and community health. Thus, the culture of advocacy is different in the areas where people are cared for by nurses. Hospitals are at the forefront of research implementation and innovation. Various entities, such as The Joint Commission, the CMS, state hospital associations, and health plans, pressure hospitals for participation in quality measures. The ANA developed the Magnet program to recognize nursing excellence and is a tool for recruiting nursing staff and enhancing the reputation of the facility (Draper, Felland, Liebhaber, & Melichar, 2008). Draper, et al. (2008) identified strategies to foster QI, including:

· Supportive hospital leadership actively engaged at work;

· Setting expectation for all staff—not just nurses—that quality is a shared responsibility;

· Holding staff accountable for individual roles;

· Inspiring and using physicians and nurses to champion efforts; and

· Providing ongoing, visible and useful feedback to engage staff effectively. (para. 1)

Clinics care for a variety of people from wellness checks to the management of debilitating and life-threatening diseases. The culture in most clinics is time-sensitive. Patients have only a limited time with the providers and nurses. Preparation of materials and patient teaching by nurses can be accomplished prior or following a provider’s examination. Nurse practitioners can do both, or the tasks can be accomplished with the help of another RN. The culture change to be patient-centered rather than time constrained is developing at large clinic systems, such as the Mayo Clinic. Other large systems are developing “medical homes” that are disease specific that provide focused education and treatment. The first such homes developed were for diabetics, those with cardiac events, and those with CHF. More of these medical homes are being developed, including asthma and chronic lung issues.

In rehabilitation settings, the culture of advocacy is driven by the protocols developed to return the patient to the presurgical status or the level of independence prior to an event. For example, rehabilitation patients include hip fractures and orthopedic surgery patients, stroke patients, and even cardiac rehabilitation, which is typically done in an outpatient setting. If the rehabilitation culture values known protocols, intensive teaching, and safety in care, then EBP are effective guidelines.

Case management are positions in which RNs are valuable. They understand the needs of patients and possess knowledge about resources. These RNs often visit the patient and family the first day of hospitalization. Planning is essential to return the patient to optimum status and safety. According to guidelines, case managers recommend the next steps needed, whether it is returning to their normal living arrangements or whether interventions or equipment is needed. Often, this planning helps to prevent patients from being readmitted due to lack of support. Often, the patient or family overestimate what they can do on a longer-term basis, and the patient’s condition can quickly deteriorate.

Home health is a further extension into the consistent quality care of patients. For example, a person can be discharged from the hospital or the rehabilitation facility, but still need further care at home. The RN evaluates the home setting for safety, the family or caregivers for the level of care they can provide, and the need for personal care such as bathing or housekeeping. Following home care practices by reputable agencies can help keep patients safe and in their homes. This leads to advocacy in community health. Training, autonomy, and involvement with the community enables community health workers to identify safety issues in the community, work with clients to make their voices heard, and make sure the proper medications are being taken. Funding for these issues is important, as it helps to reduce disparity in neighborhoods, such advocating for grocery stores that bring healthy fruits and vegetables into communities.

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The patients and staff will all benefit from patient-sensitive outcomes, improved health care outcomes, safety of patients and staff, and the economical use of resources. These should all be attractive outcomes for nursing administrators in all practice areas; however, if a dedicated EBP team does not exist in the practicing RN’s workplace, an RN can empower their profession to create one or assemble a team to implement a unit-based EBP change. RNs who have an interest in a topic or a desire to change a process to improve care can be advocates for implementation. Recent graduates and experienced staff both have strengths that complement each other. The novice has knowledge of current EBP and experience searching for evidence, which he or she can teach the seasoned nurse. The seasoned nurse has the strength of experience and confidence to support the recent graduate. Together, they can form a stronger team to talk to key stakeholders, such as their supervisor or manager, and potentially create EBP to advocate for patients.

Evidence-Based Guidelines

Evidence-based guidelines (EBGs)  are readily available through many sites. The Agency for Healthcare Research and Quality (AHRQ) develop and refine guidelines. These include the synthesis of the  best research evidence , including  directives for practice developed by health care experts in a variety of areas. At the time of this writing, the AHRQ has 1,338 guidelines across all clinical specialties and 179 in nursing alone (Agency for Healthcare Research and Quality [AHRQ], 2014). There is a great deal of information already developed, so part of the work is done for the project development team. An example can arise from any area of nursing. Using the AHRQ site, EBGs could be a great place to start to impact change in an EBP issue.

Community Health and Health Promotion EBG

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In the community health sector, health promotion EBGs are well developed. Concerning community health and health promotions, there are many issues to choose from, such as isolation of the elderly, guidelines for pregnancy issues, and maintaining healthy weight. “Maintaining a healthy weight and preventing excess weight gain among adults and children,” is an AHRQ (2015) EBG that begins with a section indicating who should take action. Then it goes on to list and describe in detail all health care providers to be involved. Two of the guidelines include encouraging people to make changes with existing advice and to engage in regular physical exercise. Many interventions are described, and many have links to research right from the guideline. RNs interested in the subject of maintaining healthy weight for the prevention of obesity-related diseases could review the guidelines and implement some part of it in the community and introduce EBP into schools. Pediatric practices could also use these EBGs in monitoring and educating children and their parents.

Rogers’s Theory of Diffusion of Innovations

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Rogers’s theory of diffusion of interventions also promotes implementing and sustaining EBP changes. It reveals how people react to change and what is needed to make permanent changes. This theory was developed to explain how, why, and the rate at which ideas spread through cultures. Rogers suggested that to move forward with an innovation or new idea, the practice change must:

· Have an advantage over the idea or process that it is replacing;

· Be compatible with the values, experiences, and needs of adopters;

· Have the ability to be trialed; and

· Be visible to others (Gale & Schaffer, 2009, p. 92)

Change agents facilitate the flow of communication about the innovation to the users of the change. Champions support an innovation and help to overcome resistance and indifference. Putting this theory of diffusion of innovations into practice includes providing time for the change to take place. Providing the staff with a clear explanation of the need for the change and the advantages from the patient’s standpoint is most powerful. “Diffusion is a social process that involves interpersonal communication and relationships. The 5 steps in the innovation decision

process are (1) knowledge, (2) persuasion, (3) decision, (4) implementation, and (5) confirmation” (Gale & Schaffer, 2009, p. 92). RNs understand adopting EBP changes into their practice is part of their role, and they feel it is part of being accountable and professional. Communication and the ability to answer staff questions are essential to a successful change.

The Future of Nursing Research

National Institute of Nursing Research Strategic Plan

Following the publication of the Institute’s 2011 Strategic Plan, the National Institute of Nursing Research (NINR) sought to implement programs of research in each of the topics identified … Building on that Strategic Plan, past scientific accomplishments, and current research priorities, four areas of scientific focus emerged:

· Symptom Science: Promoting Personalized Health Strategies

· Wellness: Promoting Health and Preventing Disease

· Self-Management: Improving Quality of Life for Individuals with Chronic Illness

· End-of-Life and Palliative Care: The Science of Compassion

In addition, NINR identified two cross-cutting areas vital to the advancement of nursing science NINR emphasizes these areas in its programs and activities.  Promoting Innovation: Technology to Improve Health 21st Century Nurse Scientists: Innovative Strategies for Research Careers. (NINR, 2016, p.7)

A quantitative study (Collins-McNeil, Edwards, Batch, Benbow, McDougald, & Sharpe, 2012) identified an innovative approach to help with disease management of type 2 diabetes among African-Americans, addressing the strategic plan’s scientific focus on self-management. This community approach used a church-based, 12-week intervention that used community resources supporting a Christian worldview. The sessions included spiritual issues such as coping, prayer, discussions with clergy, scriptures, and praise and worship. Clinical measures showed improvement in systolic blood pressure, blood lipids, physical activity, and waist circumference. Positive trends in HgA1c and depression were also noted. Clearly, this is one example of how the future of nursing is guided by research studies, implementations of EBP, and innovations in various nursing practices for the improved health and care of populations.

Lifelong Learning

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“Participating in nursing research and continuing to build the foundation of evidence-based nursing practice adds the credential that increasingly places nurses at the table in the health care policy arena. Policymakers are calling on nursing to shape the future of health care” (Fights, 2012, p 58). The  Future of Nursing report (IOM, 2010) discusses the need for an increase in baccalaureate-prepared RNs as well as an increase in the number of nurses who attain master’s and doctoral degrees. Not all nurses will pursue higher education, but there are many ways to pursue lifelong learning. Continuing education is widely available through online sources, journals, conferences, and certification processes. All of these educational processes can increase the understanding of the interconnectedness between research evidence, best practices, patient outcomes, and cost containment. “The  Future of Nursing report (IOM, 2010) calls for nurses to act as full partners in the redesign of the health care system. If nursing doesn’t answer the call, others will” (Fights, 2012, p. 57).

Reflective Summary

The use of nursing research in implementing changes in EBP is an ongoing process. As patients’ diseases are becoming more complex, the aging of people with multiple chronic diseases is increasing, and technology is expanding, making the role of nurses pivotal to the improvement of patient outcomes. RNs are well positioned to identify problems and affect the care that patients receive. For example, they implement improved ways to prevent falls, to catch adverse outcomes from medications, and to identify when a patient needs interventions to prevent a failure to rescue, among many others. Nursing involvement alone is insufficient, but day-to-day coordination of care and services for patients is an essential role of nurses. All staff members need to be engaged, including team members such as administration, physicians, other clinical staff, pharmacists, and physical therapists as well as nonclinical staff, including food service, materials management, and housekeeping. Utilizing quality improvement initiatives, following models for evaluating and implementing EBP, and following known research methods to study and reduce the gaps in the known research are important initiatives for RNs.

Check for Understanding

1. Why would the NINR develop a strategic plan for current research priorities?

2. Which of the four areas of scientific focus is important to your priorities? Why?

3. Identify at least one barrier to research and implementation of EBP. How can this barrier be reduced or eliminated?

4. How do models assist in developing and implementing a practice change?

5. Why is the concept of lifelong learning valuable in promoting nursing research and use of EBP?

Key Terms

Best Research Evidence: Research, clinical expertise, and patient values used to make decisions to improve clinical practice, patient outcomes, or the work environment.

Clinical Practice Guidelines (CPGs): Tools to support informed clinical decisions for clinicians, organizations, and patients.

Evidence-Based Guidelines (EBG): Systematically developed statements designed to help administrators, practitioners, and patients make decisions about appropriate health care for specific circumstances.

Evidence-Based Practice (EBP): The integration of clinical expertise, the most up-to-date research, and patient’s preferences to formulate and implement best practices for patient care.

Evidence Synthesis: An evaluation of multiple sources of research material that highlights similarities, differences, and connections.

Lifelong Learning: Formal and informal learning opportunities throughout nurses’ lives to utilize continuous development and improvement of the knowledge and skills for nursing practice.

PICOT Statement: A system for formulating a clear research question; P is for problem or population, I is for intervention, C is for comparison, O is for outcome of interest, and T is for time of study.

Reliability: The extent to which an experiment, test, or measuring procedure yields the same results on repeated trials.

Validity: The extent to which a concept, conclusion or measurement is well-founded and corresponds accurately to the real world.

References

Agency for Healthcare Research and Quality. (2014). Clinical practice guidelines archive. Retrieved from www.ahrq.gov /professionals/clinicians-providers/guidelines-recommendations/archive.html

Agency for Healthcare Research and Quality. (2015). Maintaining a healthy weight and preventing excess weight gain among adults and children. Retrieved from https://www.guideline.gov/summaries/summary/49117/maintaining-a-healthy-weight-and-preventing-excess-weight-gain-among-adults-and-children?q=maintaining+a+healthy+weight+and+preventing+excess+weight+gain+among+adults+and+children

Athanasakis, E. (2013). Nurses’ research behavior and barriers to research utilization into clinical nursing practice: A closer look.  International Journal of Caring Sciences, 6(1), 16-28.

Cleveland Clinic (2015). The importance of shared governance in achieving nursing excellence; ANCC recognitions are built on shared governance. Retrieved from https://consultqd.clevelandclinic.org/the-importance-of-shared-governance-in-achieving-nursing-excellence/

Collins-McNeil, J., Edwards, C. L., Batch, B. C., Benbow, D., McDougald, C. S., & Sharpe, D. (2012). A culturally targeted self-management program for African Americans with type 2 diabetes.  Canadian Journal of Nursing Research, 44(4), 126-141.

Cope, D. (2014). Analysis and use of different research review approaches in nursing.  Oncology Nursing Forum, 41(2), 207-208. doi:10.1188/14.ONF.207-208

Doody, C., & Doody, O. (2011). Introducing evidence into nursing practice: Using the IOWA model.  British Journal of Nursing, 20(11), 661-664. doi: 10.12968/bjon.2011.20.11.661

Draper, D. A., Felland, L. E., Liebhaber, A., & Melichar, L. (2008). The role of nurses in hospital quality improvement. Center for Studying Health System Change. Retrieved from http://www.hschange.org/CONTENT/972/972.pdf

Fights, S. D. (2012). Nurses lead from where we stand: How can you impact the future of nursing?  Medical-Surgical Nursing, 21(2), 57-58.

Funk, S. G., Champagne, M. T., Wiese, R. A., & Tornquist, E. M. (1991). Barriers: The barriers to research utilization scale.  Applied Nursing Research, 4(1), 39–45.

Friesen, M. A., Brady, J. M., Milligan, R., & Christensen, M. (2017). Findings from a pilot study: Bringing evidence-based practice to the bedside.  Worldviews on Evidence-Based Nursing, 14(1), 22-34.

Gale, B. V., & Shaffer, M. A. (2009). Organizational readiness for evidence-based practice.  Journal of Nursing Administration, 39(2), 91-97.

Ginex, P. K. (2017). The difference between quality improvement, evidence-based practice and research. Retrieved from https://voice.ons.org/news-and-views/oncology-research-quality-improvement-evidence-based-practice

Institute of Medicine. (2010).  The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

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