The invaluable information you have learned in this course will help you be able to transform your nursing practice. We will end the course by learning the concepts of evidence to practice and implementing practice change based on evidence. As you explore your final Week 8 content, reflect on the following questions:

How has your thinking changed as a result of the knowledge and insight that you have gained in this course?

What plans do you have for utilizing evidence-based practice to transform healthcare?

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones and Bartlett.

Evidence to Practice

This course has taught you the research process, how to read research reports/published literature, and select research-based evidence that will form the basis for your practice. According to AACN (2008), “scholarship for the baccalaureate graduate involves identification of practice issues; appraisal and integration of evidence; and evaluation of outcomes” (p.15). Now, it is time to think about how you will connect evidence to your practice. The one role that all nurses play is that of knowledge worker. No longer should nurses use reliance on traditions, myths, and outdated resources. According to QSEN (2020), health care professionals should have “an appreciation of a scientific basis for practice and value EBP as integral in determining best clinical practice” (para EBP). NR439 has helped you to recognize the value of research and EBP, identify knowledge/practice gaps, and to search and apply research-based evidence to fill them.

The first step in incorporating evidence-based research findings is to reflect on a clinical situation. Problems are all around us – some are small and easily managed, while others are significant and require further investigation. Examples of significant problems include medication errors or patient falls. Think about a significant nursing practice problem that you would like to improve by searching for evidence.

Next, it is important to use a PICO-formatted clinical question as the basis for a systematic database search to find research regarding the situation or problem. Your PICO elements are turned into key terms that you use to find research-based evidence in databases, such as Medline or CINAHL. Published authors will indicate key terms associated with the research reports/articles. The database stores the abstract or article along with its key terms.

When you search, the database looks for abstracts and articles with key terms that are similar to your key terms. The database returns information about sources that match! Once you have a reasonable number of returns, you look through them to discover those that are likely to yield evidence related to your problem.

When you find the relevant literature, you will analyze the results, the credibility of the findings, and the level of evidence. In addition to the evidence, you will need to consider the practice organizational structure, the feasibility, benefits, and risks of adopting the assigned research findings into practice.

Implementing Practice Change Based on Evidence

Think about a practice problem you are concerned about. You may propose a change based on evidence that will positively affect the problem or issue. It is important to consider available resources, including finances, personnel, and time, to implement evidence-based practice in this step.

Evidence-based Practice Image Description

Sometimes, a pilot study may be conducted, in which both the process of implementing the evidence-based practice change and the outcome of this EBP change are evaluated. The stakeholders will decide to adapt the change or adopt the change in the pilot study. If the evidence-based practice change is rejected, then the organization must decide on how to proceed to address the problem or issue that still exists.

Once the decision to adapt or adopt the evidence-based practice changes, the change must be communicated to a wide range of stakeholders within the organization. Planning will be necessary to address changes such as forms, equipment, policy, procedures, and standards of practice. In addition, education is necessary to implement evidence-based practice changes. Finally, a system must be created to monitor the progress and outcomes of the new implementation of evidence-based practice.

Barriers to Evidence-Based Practice

Barriers may be encountered when engaging in evidence-based practice. These barriers must be recognized in order to manage and overcome them.

Change

Sometimes, the barrier is not related to the specific change that has been proposed, but rather to change itself. Change within any organization can be a difficult process. The organization may not be aware of newer evidence due to lack of perceived value, lack of support, lack of ability to understand nursing research, lack of availability, and lack of time.

In order to facilitate the underlying issues, it is essential to create an environment to support evidence-based practice. For instance, it is important to anticipate the resistance to change with proactive education. In addition, a research committee can enhance the development and delivery of up-to-date evidence and knowledge.

Authority

Authority to make a change is another common barrier to evidence-based practice. Change cannot be facilitated by one person alone. If you find evidence that supports a change, consider how you would go about instituting the change process. For example, policy or procedures may need attention, staff may require training or new equipment may need to be purchased. If you change your own practice with respect to one of these examples, but no one else in the organization changes, the net effect could be to make the situation worse rather than improve it.

It is important to recognize who holds power within an organization to make evidence-based practice changes. Consider who you would approach with a good idea for a change. Would you discuss this with your supervisor? How about asking to speak to a committee that has decision-making authority? Work through the appropriate channels to create a positive impact.

Time

Time is another barrier to evidence-based practice. Many members of an organization have difficulty finding the time to strategically plan and implement a significant change. Yet, the time must be found or the problems will not be resolved.

Research

You may discover that there is a lack of research on the topic that you wish to investigate. Existing research may be sparse, outdated, or so narrowly focused that it cannot be generalized to your population. The situation is improving, but more funding is needed. Take opportunities to influence policy decisions on what research is pursued.

You can impact your practice.  Regardless of where you work, in a large organization or a small rural hospital, you can be the difference maker in your organization. Using evidence to improve practice empowers nurses to make decisions, have a voice, and critically think. Evidence-based practice can be a part of your culture and can be used to achieve nursing excellence. Nurses affect change from the bedside, think through the processes, consult with councils as necessary, and make change as a collective body.  After taking NR439, you have the power to influence excellence at the bedside, where patient care actually happens.

Facilitators to Evidence-Based Practice

Nurses are overcoming these barriers to evidence-based practice. Successful strategies include:

• nursing journal clubs where participants search for evidence and share with others;
• subscriptions to databases that allow staff to search;
• internet access that allow staff to search for evidence;
• support staff that assist with gathering data, scanning the literature, and finding evidence;
• creating a culture of evidence-based practice within the organization;
• joining professional organizations that disseminate evidence to their members.

(Houser, 2018)

Think about the role you will play in helping nursing achieve a practice based on evidence. Our future depends on the important, valuable role each of us will play in helping to achieve excellence in nursing.

Summary

You are encouraged to look around your own clinical setting or reflect upon nursing issues for situations that would benefit from evidence-based practice. Opportunities for EBP are all around!

Searching for evidence and reading research reports are skills that will serve you well throughout your nursing career, and just like any skill, practice improves performance. Make a habit of formulating clinical questions and looking for evidence. As your skill grows, so will your ability to solve clinical problems by connecting evidence to nursing practice.

References

American Association of Colleges of Nurses. (2008). Executive summary: The essentials of baccalaureate education for professional nursing practice. http://www.aacnnursing.org/Education-Resources/AACN-Essentials

Houser, J. (2018). Nursing research: Reading, using, and creating evidence (4th ed.). Jones and Bartlett.

QSEN Institute. (2020). QSEN competencies. http://qsen.org/competencies/pre-licensure-ksas/