Evidence-based Practice Initiatives Research Articles

Near-Infrared Technology for Improved PIVC Placement: A Clinical Technology Implementation Model

ABSTRACT Aims: To share lessons learned from an evidence-based practice (EBP) initiative that implemented near-infrared (NIR) technology in a large US hospital system. A Clinical Technology Implementation Model (CTIM©) that can be adapted for use in other health institutions is presented. Background: EBP implementation, including the adoption of new cutting-edge technologies, is crucial to improving patient care. Yet there are significant delays in changes to clinical practice, often due to organisational challenges that stifle the implementation process. The evidence−practice gap is increasingly evident in peripheral intravenous access (PIV). Implementation science offers new insights into the challenges of updating clinical practice, which can support EBP implementation. Evaluation: Recent literature on implementation science, change theory, PIV access, NIR technology, and patient outcomes were reviewed. A model that can help nurse managers implement technology that aligns with EBP is presented, drawing on experience from the adoption of NIR vein visualisation to enhance PIV access in a large US hospital system. Key issue: A pervasive hesitancy in healthcare to embrace technology, coupled with the challenges of implementing a change to practice, has led to limited application of EBP PIV access guidelines and a stagnant standard of care. Conclusion: This article provides nurse managers with the tools necessary to successfully implement EBP, drawing on the experience from implementing NIR in a large US hospital. Nurse managers are uniquely positioned to lead the way in embracing technology to improve care and reduce the evidence−practice gap.

A Comparison of Evidence-Based Practice Training With and Without Postimmersion Follow-up.

The aim of this study was to determine best practice for evidence-based practice (EBP) education that leads to implementation. Current methods of teaching EBP do not reliably translate to implementation. Participants in an EBP immersion were compared with participants in EBP immersion plus a follow-up EBP course. The EBP immersion group implemented 18% of their initiatives. The EBP immersion plus the follow-up EBP course implemented 35% of their initiatives, and an additional 22% were in the process of implementation. Evidence-based practice education may not be sufficient in promoting EBP implementation. Additional ongoing support may be needed to bring EBP initiatives through implementation.

Near-infrared technology for improved PIVC placement: a clinical technology implementation model.

To share lessons learned from an evidence-based practice (EBP) initiative that implemented near-infrared (NIR) technology in a large US hospital system. A Clinical Technology Implementation Model (CTIM©) that can be adapted for use in other health institutions is presented. EBP implementation, including the adoption of new cutting-edge technologies, is crucial to improving patient care. Yet there are significant delays in changes to clinical practice, often due to organisational challenges that stifle the implementation process. The evidence-practice gap is increasingly evident in peripheral intravenous access (PIV). Implementation science offers new insights into the challenges of updating clinical practice, which can support EBP implementation. Recent literature on implementation science, change theory, PIV access, NIR technology, and patient outcomes were reviewed. A model that can help nurse managers implement technology that aligns with EBP is presented, drawing on experience from the adoption of NIR vein visualisation to enhance PIV access in a large US hospital system. A pervasive hesitancy in healthcare to embrace technology, coupled with the challenges of implementing a change to practice, has led to limited application of EBP PIV access guidelines and a stagnant standard of care. This article provides nurse managers with the tools necessary to successfully implement EBP, drawing on the experience from implementing NIR in a large US hospital. Nurse managers are uniquely positioned to lead the way in embracing technology to improve care and reduce the evidence-practice gap.

Reflections on the Past Decade in Evidence-Based Practice Within the Children's Oncology Group.

Background: The Children's Oncology Group (COG) is the only National Cancer Institute-supported clinical trials organization focused exclusively on childhood and adolescent cancer research. The COG Nursing Discipline Committee has embedded the tenets of evidence-based practice (EBP) into clinical trials nursing in order to standardize the nursing care delivered to children enrolled on these trials. The COG nursing EBP initiative is aimed at developing evidence-based clinical resources and tools to provide guidance to clinicians regarding topics relevant to the provision of cancer treatment for patients enrolled on COG clinical trials from diagnosis through survivorship. A rigorous, evidence-based process designed to guide development of the evidence-based clinical tools and resources within the COG nursing discipline was developed and was implemented with the first nurse expert team beginning in 2012. Method: The standardized process included (a) selecting EBP projects and nursing expert teams (NETs), (b) providing leadership, mentoring, and championship for NETs; (c) approving clinical content developed through the NETs; and (d) providing guidance and oversight over planned dissemination of the COG EBP projects. Results: The COG Nursing EBP Subcommittee has developed 15 publications to date that include 90 authors. Eleven of these authors contributed to multiple publications. Discussion: On this 10th anniversary of the development of the EBP within the COG nursing discipline, we recognize its contributions to the professional growth of many of the discipline's members and to advances in nursing care for children enrolled in pediatric cancer clinical trials.

Role of Magnet®-recognized hospital nurse managers in implementing evidence-based practice: A mixed-method study.

Healthcare systems recognize evidence-based practice (EBP) as the prestigious standard for providing safe and high-quality patient care, nursing excellence, and Magnet Recognition. Despite the well-documented benefits, implementation of EBP is inconsistent and remains elusive in the US and throughout the world and many patients still fail to receive evidence-based care. The literature revealed a huge gap between nursing science and practice but provided evidence that nurse managers (NMs) had a pivotal leadership role in implementing EBP. To gain a deeper understanding of Magnet-recognized hospital nurse managers' (MRHNMs) leadership roles, the influencing factors, and their experience in implementing EBP to enhance EBP initiatives and sustain Magnet recognition. This mixed-method study guided by Goodall's (Australasian Psychiatry, 2016. 24, 231) theory of expert leadership used a sequential explanatory method with a quantitative-driven design based on a national correlational survey augmented by a qualitative descriptive component using semi-structured interviews. The findings of the study demonstrated that MRHNMs had a 54.6% effective leadership role in implementing EBP and produced numerous themes indicating that MRHNMs did implement EBP with struggle. MRHNMs in this study viewed EBP as a healthcare priority and leadership of NMs is necessary to promote EBP. However, lack of knowledge, difficulties with the EBP process, time constraints, and staffing issues negatively impacted EBP. Postgraduate degree, formal EBP education, critical care units as workplace, collaboration with doctorally prepared nurses, and Magnet culture enhanced EBP among MRHNMs. EBP is essential for Magnet recognition and is a hallmark of nursing excellence, however, is a complex and challenging process. The leadership of NMs is necessary to shape evidence-based care, and NMs require EBP preparation during leadership training, necessary resources, and time to complete the EBP process. EBP cannot become a reality without leaders being engaged, supportive, and persistent.

Children's Oncology Group 2023 blueprint: Nursing discipline.

In contrast to other Children's Oncology Group (COG) committees, the COG nursing discipline is unique in that it provides the infrastructure necessary for nurses to support COG clinical trials and implements a research agenda aimed at scientific discovery. This hybrid focus of the discipline reflects the varied roles and expertise within pediatric oncology clinical trials nursing that encompass clinical care, leadership, and research. Nurses are broadly represented across COG disease, domain, and administrative committees, and are assigned to all clinically focused protocols. Equally important is the provision of clinical trials-specific education and training for nurses caring for patients on COG trials. Nurses involved in the discipline's evidence-based practice initiative have published a wide array of systematic reviews on topics of clinical importance to the discipline. Nurses also develop and lead research studies within COG, including stand-alone studies and aims embedded in disease/ treatment trials. Additionally, the nursing discipline is charged with responsibility for developing patient/family educational resources within COG. Looking to the future, the nursing discipline will continue to support COG clinical trials through a multifaceted approach, with a particular focus on patient-reported outcomes and health equity/disparities, and development of interventions to better understand and address illness-related distress in children with cancer.

A Structural Model of Organization and Clinician Factors Associated with Standardized Measure Use in a National Survey of Youth Mental Health Providers.

Standardized assessment measures are important for accurate diagnosis of mental health problems and for treatment planning and evaluation. However, little is known about youth mental health providers' typical use of standardized measures across disciplines and outside the context of evidence-based practice initiatives. A multidisciplinary national survey examined the frequency with which 674 youth mental health providers administer standardized and unstandardized measures, and the extent to which organizational (i.e., implementation climate, rigid hierarchical organizational structure) and provider (i.e., attitudes toward standardized assessment measures, highest degree, practice setting) characteristics are associated with standardized measure use. Providers used unstandardized measures far more frequently than standardized measures. Providers' perceptions (a) that standardized measures are practical or feasible, (b) that their organization supports and values evidence-based practices, and (c) that their organization has a rigid hierarchical structure predicted greater use of standardized measures. Working in schools predicted less frequent SMU, while working in higher education and other professional settings predicted more frequent SMU. Standardized measures were not routinely used in this community-based sample. A rigid hierarchical organizational structure may be conducive to more frequent administration of standardized measures, but it is unclear whether such providers actually utilize these measures for clinical decision-making. Alternative strategies to promote standardized measure use may include promoting organizational cultures that value empirical data and encouraging use of standardized measures and training providers to use pragmatic standardized measures for clinical decision making.

Using Project-Based Learning to Teach Advanced Practice Nurses About Quality Improvement

Using Project-Based Learning to Teach Advanced Practice Nurses About Quality Improvement

A guide for publishing evidence-based practice projects and initiatives across disciplines

EBP is a systematic problem-solving approach to health care delivery that reduces cost, improves quality and population health outcomes and empowers clinicians to engage in their role fully. The current literature reflects that there are many long-standing barriers to implementing EBP, including barriers to publishing such as fear of writing, lack of mentoring of writing and the lack of space and structure in journals to promote EBP work. To address these challenges, a team of experts from The Fuld Institute for EBP created a comprehensive tool to support the dissemination of EBP work and provide a platform that highlights the rigorous methodological approach that takes place in high-quality EBP work. As more clinicians have access to well-done, well-described EBP work, redundancy of EBP work will be reduced, resulting in cost mitigation, while the implementation of EBP will be accelerated, leading to enhanced quality of care, and improved healthcare outcomes.

TriService Nursing Research Program: A critical component to support military nursing science

TriService Nursing Research Program: A critical component to support military nursing science

Using a Strategy Process Framework to Support the Implementation of an Evidence-Based Practice Initiative to Improve Clinical Judgment of Newly Hired Nurses.

Evidence-based practice (EBP) is foundational to nursing practice, but initiatives can be challenging to implement and sustain. A strategic process framework can successfully guide EBP initiatives. This column describes how nursing professional development specialists can teach nurses how to use a strategy process framework to guide an EBP initiative. [J Contin Educ Nurs. 2022;53(11):483-485.].

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

Strategies to Sustain Quality Interventions: Case Examples of Chlorhexidine Gluconate Bathing.

Reducing Hospital-Acquired Pressure Injuries During the COVID-19 Pandemic.

Reducing Hospital-Acquired Pressure Injuries During the COVID-19 Pandemic.

Consultation and professional development within the prolonged exposure initiative.

Previous studies have identified that ongoing consultation and organizational support are key factors in sustaining evidence-based implementation initiatives in community mental health. Clinician-level factors likely influence implementation but are not well delineated. This study assessed clinician-reported professional development incentives for participating in consultation in prolonged exposure (PE) therapy to guide future evidence-based practice (EBP)initiatives. Providers in the PE initiative (N = 22) completed a survey asking about their motivations to participate, the impact of consultation on the implementation of PEand their professional development goals, and the impact of organizational-level support on their goals and on organizational-level clinician turnover. Of the respondents, 10 had decided to pursue additional training to become PE consultants at their agencies. Providers (response rate = 22/35) reported joining the PE Initiative to learn an evidence-based practice in general (not PE specifically) and increase their skill in treating posttraumatic stress disorder. Providers largely found ongoing consultation helpful and reported that consultation provided the feedback and support necessary to achieve their professional goals. Providers who decided to pursue PE consultant training reported that expanding upon supervision and clinical skills were strong motivators. Providers largely attributed clinician turnover within the PE Initiative to organizational-level factors. Ongoing consultation facilitated providers' professional development goals. The survey identified several areas for further exploration, including how consultation can reduce clinician turnover, and how taking on additional responsibility within implementation initiatives can facilitate provider engagement in the EBP.

Geriatric Syndrome Screening: Implementing an Evidence-Based Process in Hospitalized Older Adults With Cancer.

Oncology nurses are in a key position to screen patients for geriatric syndromes that can disproportionately affect older adults with cancer. Early recognition can promote informed decision-making, initiation of interventions, and tolerance of treatment. This study aimed to implement a nursing-sensitive screening process to identify types and frequency of geriatric syndromes in hospitalized older adult patients with cancer. Nurses were trained to screen for geriatric syndromes using the SPICES tool (sleep disorders, problems with eating or feeding, incontinence, confusion, evidence of falls, and skin breakdown). The electronic health record was leveraged to facilitate documentation and provide a geriatric syndrome profile for each patient. Results demonstrated ability of staff nurses to lead an evidence-based practice initiative and the challenges faced. Adherence to SPICES screening was 47%. About 80% of patients had two or more geriatric syndrome issues.

Assessing Evidence-Based Practice Knowledge: An Innovative Approach by a Nursing Research Council.

The aim of this study was to describe the structure and processes implemented by nursing research councils to conduct a nurse-led research study at an urban community teaching hospital. We assessed nurses' knowledge, skills, and attitudes toward evidence-based practice (EBP) to inform development plans. This is an institutional review board-approved single-site cross-sectional anonymous online survey (Evidence-Based Practice Questionnaire [EBPQ]) emailed to 850 participants. Data were analyzed using SPSS v25 (Armonk, New York). Initial response rate was 11%. Deployment of new strategies achieved an overall response rate of 57.5%. EBPQ subscale scores were highest for "attitude," followed by "knowledge/skills," and "practice." Lowest-scoring items included critical appraisal of literature, converting information needs into a question, time for new evidence, information technology, and research skills. Our EBPQ scores were consistent with prior findings. Our strategies provide a framework for other institutions in similar stages of implementing EBP and nurse-led research initiatives.

Pain Management Education Initiative: Creating S.T.A.R.S. (Specialized Treatment Approach Requires a Skill-set)

Effective pain management is a key component of patient care on a surgical unit. It was identified that there was an opportunity to improve nurse adherence and compliance with clinical practice guidelines and best practice in pain management. A pain education program was created by a pain certified nurse and nurse educator. Outcomes showed a positive trend in nurse confidence, knowledge, documentation compliance, and nurse-driven non-pharmacological interventions; pain HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) scores improved. The EBP (evidence-based practice) process was implemented to identify best pain management practices for clinical nurses. Problem identification, literature search, critical appraisal and synthesis of relevant sources were completed. A gap analysis was conducted using an online survey to assess nurses' knowledge and confidence with pain management assessments, opioid administration, and non-pharmacological interventions. Based on learning needs identified, an educational program was designed and implemented. Post implementation, audits were completed monthly to trace nurses' knowledge, confidence, documentation, and use of non-pharmacological interventions, and HCAHPS scores. Post implementation improvement consecutively for three months showed the nurse-driven non-pharmacological interventions (9% to 55%), pain assessments (33% to 52%), and use of pain management in nursing care plans (45% to 52%). HCAHPS scores (“staff discussion regarding pain”) improved from 70.5 to 72.1%, 95 to 96 percentiles. Enhanced nurses' pain management education showed marked improvement in pain management strategies and patient outcomes. This EBP initiative opened the door for a future role of a Pain Management Nurse Scholar facility wide resource to maintain outcomes and relevant ongoing education initiatives in pain management.

Advancing Evidence-Based Practice Through Implementation Science: Critical Contributions of Doctor of Nursing Practice- and Doctor of Philosophy-Prepared Nurses.

Describe the evolution of implementation science and the roles and potential collaborations of doctorally prepared nurses to advance implementation science in practice settings. Review of academic preparation and areas of expertise for doctorally prepared nurses as it relates to implementation science and evidence-based practice (EBP). There have been substantial gains in the number of academic programs in healthcare that include content on EBP, resulting in healthcare teams that are motivated to align practices with best evidence. Unfortunately, many EBP initiatives stall during early stages of implementation, resulting in fragmented practices and persistent gaps between evidence and practice. Implementation science aims to bridge this gap and provides a structured, science-based approach to implementation. Few healthcare teams are familiar with implementation science, and many do not incorporate knowledge from the field when implementing EBPs. Doctorally prepared nurses are in a unique position to serve as leaders in EBP implementation due to the breadth and depth of academic preparation and their pivotal roles across practice settings. Collaboratively aligning existing strengths of PhD and DNP prepared nurses with knowledge of implementation science can advance implementation of EBP across practice settings to effectively incorporate and sustain meaningful change to improve outcomes. Doctorally prepared nurses are in a unique position to advance and apply the science of implementation in practice settings. Nurse scientists can generate evidence on effective strategies and outcomes among healthcare teams to successfully integrate evidence based practices into routine care. Nurse leaders and educators can apply these findings and use an implementation science approach when leading clinical teams in evidence-based practice changes.

An Organization-Wide Initiative to Implement Parent-Performed, Delayed Immersion Bathing

ObjectiveTo implement an organization-wide evidence-based practice change to parent-performed, delayed immersion newborn bathing across nine facilities at a military health care system. DesignOrganization-wide evidence-based practice initiative using preimplementation and postimplementation data. SettingA military health system consisting of four medical centers and five community hospitals that averages 4,000 births each year. ParticipantsTerm newborns (≥37 weeks gestation) born within the nine facilities. Intervention/MeasurementsChampions were identified at each facility to change bathing practice. Baths for newborns were delayed until 24 hours of age, unless otherwise requested. Parents were instructed how to tub bathe their newborn and encouraged to complete the bath in less than 5 minutes. The team reviewed 100 records from each hospital and compared pre- and postimplementation temperature data. ResultsThe organization-wide practice change showed a statistically significant association between time point (i.e., before vs. after implementation) and postbathing hypothermia (χ2 = 30.91, p < .001). In addition, data also showed fewer hypothermic temperature readings (i.e., <97.7 °F [<36.5 °C]) from the onset of birth until 8 hours of life with the new bathing process. Although this difference was not statistically significant (p = .11), it holds clinical significance if it can be replicated; newborn hypothermia requires provider notification and can lead to additional testing to rule out infection and other concerns. ConclusionDelaying newborns’ first bath was associated with a significant decrease in the number of newborns who had hypothermic temperature readings immediately after the bath. The intervention involved minimal cost with multiple benefits. Delayed immersion bathing is a family-friendly process that can be implemented across an organization.

Frailty in Young and Middle-Aged Adults: An Integrative Review.

Frailty is a public health priority resulting in poor health outcomes and early mortality in older adults. Early identification, management, and prevention of frailty may reduce frailty trajectory into later life. However, little is known about frailty in younger adults. Describe frailty prevalence, definitions, study designs, and components contributing to multidimensional frailty in 18 to 65-year-olds and impart guidance for future research, practice, and policies with potential to positively impact frail individuals. Integrative review approach was selected to explore frailty allowing for inclusion of diverse methodologies and varied persepectives while maintaining rigor and applicability to evidence-based practice initiatives. CINAHL, Embase, PsycInfo, PubMed databases were searched for studies describing frailty in adults age 18 to 65. Articles were excluded if published prior to 2010, not in English, lacked frailty focus, or non-Western culture. Twelve descriptive correlational studies were included. No intervention or qualitative studies were identified. No standard conceptual definition of frailty was discovered. Studied in participants with health disparities (n=3) and chronic conditions (n=8); HIV was most common (n=4). Frailty prevalence ranged from 3.9% (313 of 8095) to 63% (24 of 38). Many factors associated with frailty were identified among physical (18) and social (14), and fewer among psychological (11) domains. Universal frailty definition and multidimensional assessment tool is needed to generate generalizable results in future studies describing frailty in young and middle-aged adults. Early frailty identification by clinicians has potential to facilitate development and implementation of targeted interventions to prevent or mitigate frailty progression, but additional research is needed because risk factors in younger populations may be different than older adults.