Evidence Based Practice into Clinical Practice

Melnyk_PPT_Chapter_11.ppt

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Chapter 11

Leadership Strategies and Evidence-Based Practice Competencies to Sustain a Culture and Environment That Supports Best Practice

Factors Influencing EBP Implementation

Studies have found that resistance to accepting EBP is declining; however, factors that still influence EBP implementation include:

Beliefs and attitudes about EBP
Knowledge about EBP
Organizational commitment to EBP
Organizational support for EBP
An organizational culture responsive to change
Support of EBP ideas/initiatives

Interventions Vital to Consistent Implementation of EBP

EBP education combined with active repetitive skills building
EBP mentorship and support
A culture and an environment that supports EBP
Leaders and managers who support and role model EBP
Strategies that overcome system barriers to EBP

Question

Research studies over the last two decades have found that some barriers to EBP have changed in their importance while others remain. Select all of the barriers that still have impact on building and sustaining an environment favorable to EBP:

a. Organizational support and commitment

b. Resistance to EBP implementation

c. Attitude about the importance of EBP

d. Knowledge about EBP processes

Answer

a, b, and d

Rationale: Over the last decade, studies have shown that attitude toward the importance of EBP to clinical practice has improved; however, barriers such as organizational support and commitment, resistance to EBP implementation on site, and sound knowledge about the EBP process continue to be barriers to its implementation.

Nursing Organizations That Incorporate EBP Into Their Standards and/or Expectations of Leadership

American Nurses Association (ANA) ANA Scope and Standards of Practice for the Nurse Administrator (2010)
The American Organization of Nurse Executives (AONE) AONE Nurse Executive Competencies
The American Nurses Credentialing Center (ANCC) Magnet Recognition Program

Leadership Theories for Contemporary Nursing and Healthcare Leadership

Focus on the relationship between the leader and the follower
Leader creates an environment where individuals are supported and recognized for their work
Workers feel inspired and empowered to innovate and change
Leadership theories include:
Innovation leadership
Transformational leadership
Servant leadership
Authentic leadership

Leadership Theories: Innovative Leader

Leadership that creates the context in which innovation occurs and sustains

Competencies of the innovative leader:

Focuses on the essence of the innovation
Possesses knowledge and experience in concepts and processes of innovation
Possesses an understanding of their own personal strengths and limitations
Demonstrates effective collaboration based on listening, encouraging feedback, openness, and conflict resolution

Leadership Theories: Innovative Leader—(cont.)

Competencies of the innovative leader—(cont.):

Manages considerable amounts of data and information and quickly evaluates the evidence, its value, and potential outcomes
Collects related information/evidence when gaps are identified in the information or evidence
Evaluates new technology from the perspective of enhancing the organization rather than purely as a new technology
Coaches others in the principles of innovation, adult learning, and change

Leadership Theories: Transformational Leader

Leader is the one who provides a vision and motive and is an inspiration to others

Four dimensions of transformational leadership:

Idealized influence: Role models with a focus on doing things right rather than ensuring that others do the right things

Leadership Theories: Transformational Leader—(cont.)

Four dimensions of transformational leadership—(cont.):

Inspirational motivation: Articulates a clear vision that inspires and motivates others to accomplish great achievements
Intellectual stimulation: Encourages innovation and creativity by empowering others to explore new ways of doing things and approaching problems using the EBP process
Individualized consideration: Supports and encourages others by offering reward and recognition for unique contributions

Leadership Theories: Servant Leader

Leadership based on the essential elements of trust, empathy, caring, and a focus on others

Foundational characteristics that are central to servant leadership:

Intent and careful listening to others
Seeking to understand and empathize with those they lead
Healing relationships by helping others to solve problems and conflicts, thus supporting and promoting personal growth in others

Leadership Theories: Servant Leader— (cont.)

Foundational characteristics that are central to servant leadership—(cont.):

Self-awareness that allows a better understanding of issues surrounding ethics, power, and values
Ability to build consensus among others and a reliance on persuasion rather than power to influence
Seeing beyond the “day-to-day” and focusing on long-term goals
Learning from the past to understand the present consequences of decisions

Leadership Theories: Servant Leader— (cont.)

Foundational characteristics that are central to servant leadership—(cont.):

Belief that serving the needs of others is an obligation
Commitment to the personal, professional, and spiritual growth and development of each individual
Desire to develop a true community among businesses served

Leadership Theories: Authentic Leader

A composite of other leadership types; these leaders are confident, hopeful, optimistic, resilient, transparent, self-aware, and possess high moral character. They assure that their communication is transparent and comprehended as intended.

Leadership based on four central behaviors:

Balanced processing: Ability to objectively analyze data to formulate decisions while soliciting views that may challenge ideas without being self-protective

Leadership Theories: Authentic Leader—(cont.)

Leadership based on four central behaviors—(cont.):

Internalized moral perspective: Role models high standards of moral and ethical conduct
Relational transparency: Presents genuine self to followers and shares their values, emotions, and goals in a transparent manner that encourages others to be forthcoming with their ideas and opinions
Self-awareness: Assesses their strengths and weaknesses to come to a better understanding of their own unique talents, beliefs, and desires in order to enhance their leadership effectiveness

Question

There are four leadership theories that have been identified as congruent with initiating and sustaining evidence-based practice. Match the hallmark characteristics with the theory to which they belong.

a. Innovative leader	__ Doing things right rather than ensuring that others do the right things
b. Transfor-mational leader	__ Based on the essential elements of trust, empathy, caring, and a focus on others
c. Servant leader	__ Presents genuine self to followers and shares their values, emotions, and goals in a transparent manner
d. Authentic leader	__ Evaluates new technology from the perspective of enhancing the organization rather than purely “to be first”

Answer

In order: b, c, d, a

Rationale: Although there are some commonalities among characteristics described in leadership theories, each of the theories has at least one distinctive trait, as identified in previous PowerPoint slides and in the textbook.

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment

Strategy	Activities
EBP education and skills building	Develop EBP content and skill-building programs targeted at clinicians in various levels of practice including staff, managers, and directors Include EBP content and EBP competencies in orientation and residency programs designed for new hires

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.)

Strategy	Activities
Operational budgets for EBP resources	Purchase computers dedicated for EBP work Allot/budget time for EBP project work
Library services support	Access to library with adequate clinical databases and journals available Support from librarians knowledgeable in EBP steps and processes

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.)

Strategy	Activities
Job descriptions and performance evaluation tools	Write or revise job descriptions with EBP competencies/expectations articulated Write or revise performance appraisal tools with EBP outcomes/deliverables articulated
Clinical ladder requirements	Write or rewrite clinical ladder application with progressive EBP requirements at each level

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.)

Strategy	Activities
Organizational mission, vision, and values statements	Write or revise organizational and departmental mission, vision, and values statements with EBP language integrated throughout
EBP mentors aligned within the organization	Structure EBP mentors/champions centrally within the organization to promote, support, and sustain a unified message and vision of EBP Designate a dedicated, knowledgeable EBP leader to oversee EBP activities and create and inspire the EBP culture

Strategies and Related Activities That Eliminate Barriers to an EBP-Friendly Environment—(cont.)

Strategy	Activities
EBP mentor positions	Create specific job descriptions for designated EBP mentors (include robust knowledge and skills in EBP, motivation, and change theory) Align EBP mentors centrally in the organization
Manager and leader accountability	Write/revise leadership job descriptions to reflect clear EBP expectations Write/revise performance appraisal tools with required EBP outcomes/deliverables

Evidence-Based Practice Competencies for Practicing Registered Nurses

Questions clinical practices for the purpose of improving the quality of care
Describes clinical problems using internal (organization-generated) evidence
Participates in the formulation of clinical questions using PICOT format
Searches for external (research) evidence to answer focused clinical questions
Participates in critical appraisal of pre-appraised evidence

Evidence-Based Practice Competencies for Practicing Registered Nurses—(cont.)

Participates in the critical appraisal of published research studies to determine their strength and applicability to clinical practice
Participates in the evaluation and synthesis of a body of evidence gathered to determine its strength and applicability to clinical practice
Collects practice data systematically as internal evidence for clinical decision making
Integrates evidence gathered from external and internal sources in order to plan evidence-based practice changes

Evidence-Based Practice Competencies for Practicing Registered Nurses—(cont.)

Implements practice changes based on evidence and clinical expertise and patient preferences to improve care processes and patient outcomes
Evaluates outcomes of evidence-based decisions and practice changes for individuals, groups, and populations to determine best practices
Disseminates best practices supported by evidence to improve quality of care and patient outcomes
Participates in strategies to sustain an evidence-based practice culture

Question

Is the following statement true or false?

Evidence-based practice competencies as identified by Melnyk, Gallagher-Ford, Long, and Fineout-Overholt (2014) are basically the same for both the practicing registered nurse (RN) and the advanced practice nurse (APN).

Answer

False

Rationale: Although several of the competencies as described by Melnyk et al. (2014) are built on the practicing registered nurse competencies, several of them, such as leading interdisciplinary teams in applying synthesized evidence, are exclusive to the APN role.