nur3052 ch9

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 9Implementing Evidence in

Clinical Settings


EBP in Clinical Practice

Knowledge must be translated into clinical practice to improve patient care and outcomes

The understanding of care based on evidence is often far removed from clinical practice

Developing an environment that fosters a culture of EBP is key


Vision for EBP

Begin with a vision and an understanding of the goals to be accomplished

An image of the future is created to begin the transformation process

Often this vision is mandated

Regulatory bodies

Insurance providers

Magnet recognition


Developing a Vision for Change

Begins with a few passionate individuals

Involvement of clinical experts and EBP mentors is key

Preparation and planning are essential

Sharing the vision for excellence in practice is the most essential catalyst for promoting EBP


Promoting Engagement

Engage

Clinical staff

Administrators

Members of other disciplines


Assessing and Eliminating Barriers Even when change is welcome, it is stressful

Stakeholder resistance to change must be explored early

Barriers to be addressed include

Inadequate knowledge and skills

Weak beliefs about the value of EBP

Poor attitudes toward EBP

Lack of EBP mentors

Social and organizational influences

Economic restrictions


Question

Tell whether the following statement is true or false.

Implementation of EBP is the responsibility of graduate-prepared nurses and members of the nursing leadership.


Answer

False

Rationale: Implementation of EBP in the clinical setting is dependent on broad engagement and participation from all care providers at all levels, as well as leaders, administrators, and members of other disciplines.


Question

What is the most effective strategy for engaging care providers in a proposed EBP change?

a. Disseminate the evidence that underlies the change

b. Remind staff of their obligation to provide optimal care

c. Bring in EBP experts to speak to staff members

d. Organize discussions and meetings with EBP mentors


Answer

d. Organize discussions and meetings with EBP mentors

Rationale: Interactive discussions between EBP mentors and care providers are an effective way to increase knowledge and address attitudinal barriers. Other strategies, such as bringing in outsiders to teach, disseminating research findings, or telling caregivers that they are obliged to change, are less likely to engage them and foster genuine change.


Promoting Engagement

Prioritize clinical issues

Start with a clinical issue of direct interest to clinicians

Evaluate the infrastructure

Resources, time, and administrative support

Develop experts in the EBP process

Mentorship


Integrating EBP into Practice

Education alone will not change behavior

Establish formal implementation teams

Advanced practice and graduate-prepared nurses

Build excitement

Focus on the potential improvement in outcomes

Disseminate the evidence

Use active and engaging educational techniques


Integrating EBP into Practice (cont’d)

Develop clinical tools

Written guidelines, EBP summaries, pre-printed orders, algorithms, prompts, and reminders

Pilot test the practice change

Preserve energy sources

Develop strategies to maintain excitement and preserve energy resources

Choose a timeline carefully

Celebrate successes along the way


Evaluating Outcomes of EBP Change

An important, yet often overlooked, step in EBP

Evaluation indicators

Outcome measures – quantifiable healthcare results

Quality care improvement

Quantify how interventions impact the quality of patients’ and families’ lives

Patient-centered quality care

The value patients and families place on the healthcare received


Evaluating Outcomes of EBP Change (cont’d) Efficiency of processes

E.g., appropriate timing of interventions, effective discharge planning, and efficient utilization of hospital beds

Environmental changes

E.g., evaluation of policy and procedure adherence, unit resource availability, and healthcare professional use of supplies and materials

Professional expertise

Establishing expectations for adherence to accepted standards of care essential for best practice


Question

Which of the following evaluation indicators can be quantified and statistically analyzed?

a. Environmental changes

b. Professional expertise

c. Outcome measures

d. Patient-centered quality care


Answer

c. Outcome measures

Rationale: Outcome measures are quantifiable healthcare results, such as health status, death, disability, iatrogenic effects of treatment, health behaviors, and the economic impact of therapy and illness management. Environmental changes, professional expertise, and patient-centered quality care are measures that equally important, but which are more qualitative in nature.


Summary

An EBP environment promotes excellence in clinical care resulting in improvement of patient outcomes

Transforming a healthcare institution into a setting where an EBP culture exists requires persistence, patience, and perseverance

nur3052 ch9

Health & Medicine

ebp experts

implementation of ebp

ebp summaries

culture of ebp

proposed ebp change

ebp lack of ebp mentors

ebp mentors rationale

ebp process mentorship