Abstract
Evidence-based practice (EBP) combined with quality of care improves patient outcomes. However, there are still difficulties for its implementation in daily clinical practice. This project aims to evaluate the impact of the incorporation of the Advanced Practice Nurse (APN) role on the implementation of EBP at three levels: context, nurses’ perceptions, and clinical outcomes. Mixed-methods study in two phases is proposed. Phase 1: a quasi-experimental design where five APNs are included in five hospitalization wards that are compared with another five similar wards without APNs. Variables from Practice-Environment-Scale-Nursing-Work-Index, Health-Science-Evidence-Based-Practice-Questionnaire, and Advanced-Practice-Nursing-Competency-Assessment-Instrument are used. Clinical outcomes are followed-up with monthly. A descriptive and exploratory analysis is performed. Phase 2: an exploratory qualitative design through focus groups at the intervention wards after one year of APNs implementation. Explicative data are gathered to explain the progression of change and how actors perceive and attribute triggers, barriers, and facilitators for change. An inductive thematic analysis is performed. The inclusion of APN in hospitalization context is insufficiently studied. It is hoped that these figures provide solutions to the multiple barriers in the development of EBP in these sceneries and contribute to resolve the gap between research results and healthcare practice.
Highlights
Evidence-based clinical practice (EBCP) has become an essential tool for the improvement of decision-making in health care [1,2,3]
In order to implement this theoretical model, attention should be focused on the facilitator role of the best evidence played by the Advanced Practice Nurse (APN) [23,24]
We propose APNs be incorporated into hospital wards as a new approach to the role of advanced practice nursing in our country
Summary
Evidence-based clinical practice (EBCP) has become an essential tool for the improvement of decision-making in health care [1,2,3]. In order to implement this theoretical model, attention should be focused on the facilitator role of the best evidence played by the Advanced Practice Nurse (APN) [23,24] This approach would address two attention levels: individual, seeking to modify the work patterns of health care personnel; and organisational to facilitate this change. One of the solutions that is gaining the most popularity worldwide is to recruit APNs, whose high-level postgraduate training and advanced knowledge and skills make them very appropriate for this task, to raise the level of EBCP within a given environment In this respect, studies performed in different contexts have acknowledged the value of APNs as agents of change [27,28], capable of influencing their work environment through the transfer of evidence-based knowledge and producing disruptive innovation [29]. The specific objectives are to (1) evaluate the impact of APHNs on the EBCP environment (contextual and individual factors); (2) explore the bedside nurses and APHNs’ perceptions towards EBCP concerning the incorporation of the APHNs in their hospital ward; (3) determine the impact of APHN-directed interventions on clinical outcomes of inpatients; and (4) assess the competencies of the APHNs who take part in the project
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