Dr Samira Alsenany

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

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

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

Engage

Clinical staff

Administrators

Members of other disciplines

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

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.

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.

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

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.

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

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

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

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

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

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

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.

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