Evidence-based Practice Projects Research Articles

Reporting guidelines for evidence-based practice projects: A Delphi study and publication checklist.

Evidence-based practice (EBP) is the cornerstone of sound patient care. Despite the known importance of disseminating EBP, of the 600 reporting guidelines registered with the EQUATOR network, none exist on reporting an EBP project. This lack of guidance leads to publications that lack rigor and discourages more novice writers who may not know where to begin. The purpose of this study was to establish Reporting Guidelines for EBP projects by achieving consensus among subject matter experts (SMEs) regarding the required components for a high-quality report. This study followed a modified Delphi technique. The first round solicited free-text responses regarding reporting sections and sub-sections. The team analyzed these results and incorporated information from the literature to generate items for the second round. In the second and third rounds, participants ranked each section on a Likert scale of 1-4 (not relevant to extremely relevant) and provided free-text revision suggestions. Items that reached a 70% consensus moved from one round to the next. SMEs reached consensus on 6 sections and 30 sub-sections. Sections address the process for determining best practice recommendations as well as implementation into practice. Headers include (1) "Introduction," (2) "EBP Design," (3) "Methods to Generate Recommendations," (4) "Evidence Findings," (5) "Implementation," and (6) "Conclusion." All items are unaffiliated with specific EBP models, hierarchies, or question formats. The Reporting Guidelines for EBP Projects is a checklist of items with associated descriptors that should be addressed in articles reporting an EBP project. The intention is to provide a roadmap of the items required to publish EBP efforts. It is meant to create a set of expectation for journal editors to provide concrete guidance for authors and elevate the quality and quantity of EBP projects in the literature.

Relationship Between Original Research Experiences and Evidence-Based Practice Among Undergraduate Dental Hygiene Students.

For the dental hygiene profession, a need exists to engage students in research experiences as undergraduate students to foster interest in research and improve the implementation of evidence-based practice. The purpose was to explore the relationships between original research experiences and evidence-based practice among undergraduate dental hygiene students. This quantitative survey research study of undergraduate dental hygiene students in the USA was conducted in 2021. Original research experience was measured using the Wessex Research Network (WReN) spider instrument and evidence-based practice was measured using the Knowledge, Attitudes, Access and Confidence Evaluation (KACE) instrument. Invitation e-mails were sent to the directors of US entry-level dental hygiene programs to forward the survey e-mail message to students in the last semester of their dental hygiene programs. The data were analysed using descriptive statistics, bivariate analysis and multiple linear regression analysis. A total of 128 responses were analysed. The foundational knowledge domain of research experience was found to be a significant predictor of evidence-based practice and the mediators of evidence-based knowledge, evidence-based attitudes, evidence-based access and evidence-based confidence. Research experience was found to be a significant predictor of Evidence-Based Practice. Engaging undergraduate dental hygiene students in research opportunities may prepare students for the clinical application of evidence-based practice and original research projects.

Innovative Strategies for Palliative Care in the Intensive Care Unit.

Palliative care is interdisciplinary care that addresses suffering and improves the quality of care for patients and families when patients are facing a life-threatening illness. Palliative care needs in the intensive care unit include communication regarding diagnosis and prognosis, goals-of-care conversations, multidimensional pain and symptom management, and end-of-life care that may include withdrawal of mechanical ventilation and life support. Registered nurses spend the greatest amount of time with patients and families who are facing death and serious illness, so nurses must be armed with adequate training, knowledge, and necessary tools to address patient and caregiver needs and deliver high-quality, patient-centered palliative care. Innovative approaches to integrating palliative care are important components of care for intensive care nurses. This article reviews 2 evidence-based practice projects, a serious illness support tool and the 3 Wishes Project, to add to the palliative care toolkit for registered nurses and other team members.

Making It Stick: Effectively Implementing and Sustaining Evidence-Based Practice Projects

Making It Stick: Effectively Implementing and Sustaining Evidence-Based Practice Projects

Facilitating Evidence-Based Practice among Nurses in a Tertiary General Hospital: A Six-Year Practice of an Implementation Strategy Informed by the i-PARIHS Framework

Aims. To develop an evidence-based practice (EBP) facilitating strategy informed by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and evaluates the strategy’s effectiveness on promoting EBP. Background. Nurses are increasingly expected to use research evidence in practice to improve patients’ outcomes, but the application of such evidence is still unsatisfactory. The facilitation of EBP in nursing needs the organization and the individual levels. Methods. Based on an analysis of EBP-promoting strategies and expert consultation, the core team of the nursing department developed an EBP group-based and project-oriented strategy under the guidance of the i-PARIHS framework. The strategy was implemented for six years and evaluated by a longitudinal design. The validated Chinese version of the self-reported Evidence Based Practice Questionnaire (EBPQ) was used to assess the attitudes, knowledge, and practice of the nurses. Results. The mean score of the total EBPQ was 4.46 (SD = 0.92) after one year of the EBP strategy, and the scores for knowledge, attitudes, and practice of EBP members were higher than those of general nurses p<0.05. After four years, EBP members’ scores continued to increase. EBP groups conducted 51 EBP projects in the areas of emergency nursing, surgical and medical nursing, critical care, and so forth. Of these, 33 projects improved nursing practice by changing nursing procedures, upgrading nursing tools, and developing nursing standards, resulting in improved patient outcomes. Conclusion. The EBP group-based and project-oriented strategy can promote EBP. The composition of the EBP group, the annual audit of EBP projects, and the roles of internal and external facilitators were key components of this EBP-facilitating strategy. Implications for Nursing Management. The strategy is an organizational-level EBP-facilitation approach which can improve nurses’ academic preparation for EBP through ongoing training and sustained EBP behavior that involves annual projects.

‘Capacity building skills in the implementation of evidence-based practice for community health nurses: an exploratory descriptive cohort study’

Background: While nurses are strategically placed to support the achievement of universal health, their practice may not always be informed by evidence, especially in a context where research evidence is not commonly used to inform practice. Objective/Aim/Hypothesis: Improve management of clients with CNCDs in Caribbean community through evidence-based practice (EBP) capacity building workshops. Design/Methods: A descriptive, quantitative design was used for this study. Participants included Community Based Nurses who attended an initial and recall workshop on EBP in a Caribbean island. All participants were included as the sample. Data were collected as a Pre-Test and Post Test before the initial workshop and at the recall workshop. Analysis was done quantitatively. Since the sample was small, only descriptive statistics were used. Results: Data showed 64% of participants had no experience with EBP, 55% needed more essential resources to participate in EBP and 55% recognized a need to include EBP to change their clinical practice effectively. Conclusions: The nurses and district supervisors observed a high level of interest and commitment to initiating and completing EBP projects. However, the reality of significant workplace demands, and limitations in consistent logistical and supervisory support impacted long-term sustainability.

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.

Clinical application of multidisciplinary team- and evidence-based practice project in gynecological patients with perioperative hypothermia

BACKGROUND Perioperative hypothermia (PH) negatively affects the physical and mental health of patients to varying degrees. Currently, there is no effective multidisciplinary team (MDT) intervention for gynecological patients with PH. AIM To apply the best evidence on the prevention and management of PH in gynecological patients, improve the quality of perioperative evidence-based care based on treatment by an MDT for gynecological patients and analyze the effect of MDT- and evidence-based practice (EBP) projects on the psychological status and cognitive function of gynecological patients with PH. METHODS Under the guidance of knowledge translation and combined with the opinions of involved stakeholders and clinical experts, the best evidence for PH prevention and management in gynecological patients was selected and adjusted to suit the practice setting. Based on the evidence, the practice plan was developed, and the MDT intervention was carried out in the preoperative ward, the preoperative preparation room, the intraoperative operating room, the postanesthesia care unit, and the 24-hour postoperative gynecological ward through the EBP program. The incidence of hypothermia, the nurses’ awareness, the implementation rate of examination indicators, and the thermal comfort level, psychological status and cognitive function of patients were compared before and after the implementation of the program. RESULTS The incidence of PH in gynecological patients decreased from 43.33% to 13.33% after the implementation of the scheme. The implementation rate of examination indicators 6-10, 12, 14, 16-18, 21, and 22 reached 100%, and that of other indicators was above 90%, except for examination indicators 5 and 13, which was 66.67%; the indices were significantly improved compared with the baseline (before evidence application) (P < 0.05). The score of nurses' awareness of PH prevention and management in gynecological patients increased from 60.96 ± 9.70 to 88.08 ± 8.96, and the difference was statistically significant (P < 0.001). The total score of the perioperative thermal comfort level of patients undergoing gynecological surgery was 27.97 ± 2.04, which was significantly increased compared with the score of 21.27 ± 1.57 observed by researchers at baseline (P < 0.001). The perioperative Hamilton Depression Scale and Hamilton Anxiety Scale scores of patients undergoing gynecological surgery decreased from 15.03 ± 3.16 and 13.93 ± 2.64 to 4.30 ± 1.15 and 3.53 ± 0.78, respectively, with statistically significant differences (P < 0.001). The perioperative Montreal Cognitive Assessment Scale score of the gynecological surgery patients increased from 23.17 ± 1.68 to 26.93 ± 1.11, also with statistical significance (P < 0.001). CONCLUSION MDT-based EBP for PH prevention and management in gynecological patients during the perioperative period can standardize nursing operations, improve nurses' awareness and behavioral compliance with gynecological hypothermia management, and reduce the occurrence of PH in gynecological patients while playing a positive role in reducing patients’ negative emotions and enhancing their cognitive function.

A Nursing Research Residency Experience.

Nursing research is essential to improving patient care, yet barriers may hinder bedside nurses from participating in research and evidence-based practice (EBP) activities. This article describes a nursing research residency program that aimed to inspire direct care nurses to participate in research and EBP projects. The program described may be a potential solution to bridge the gap between clinical work and research.

Project to Publication-A Writing Mentorship Program.

Evidence is required to inform effective interventions promoting publication among clinical nurses. This study examined the effect of a mentored writing program on clinical nurse perceptions of writerly self-efficacy and publication. A mixed-methods, pretest-posttest study design with an education intervention was implemented. The Revised for Nursing Practice - Postsecondary Writerly Self-efficacy Scale (RNP-PSWSES) measured perception of writerly self-efficacy before and after intervention. Manuscripts submitted for publication were counted. The purposive, convenience sample included registered nurses with completed research, evidence-based practice, or quality improvement projects. Subjects participated in a 3-month structured mentored writing program and completed the RNP-PSWSES survey before and after program completion. A Wilcoxon signed rank test was performed to determine the significance of difference between the pretest and posttest, and the number of published manuscripts was reported. The RNP-PSWSES items identified pretest-posttest Cronbach's α (.728, .818). Posttest RNP-PSWSES scores were statistically significantly higher than pretest scores (z = -1.96, P = .050) with a large effect size of r = 0.69. Two manuscripts were accepted for publication, and 1 manuscript was withdrawn after the third request for revisions. In this study, mentored writing workshops improve nurses' perceptions of writing ability and increase publications. Generalization of findings is limited by small sample size. Clinical nurse specialists are critical to champion writing and publication.

Facilitating a Culture of Evidence-Based Practice and Quality Improvement Excellence: Streamlining Processes to Improve Care.

This article defines evidence-based practice (EBP) and quality improvement (QI) and examines the positive impact on patient care when they are in place, as well as the barriers to their implementation. An effective tool, Ovid Synthesis, was created to enable clinicians and administrators to streamline the processes for EBP and QI, provide oversight on the initiatives underway, and enable clinical educators to help nursing staff develop the necessary competencies and successfully execute their EBP and/or QI projects.

Budgetary investment in evidence-based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes.

Hospitals and healthcare systems strive to meet benchmarks for the National Database of Nursing Quality Indicator (NDNQI) measures, Centers for Medicare & Medicaid Services (CMS) Core Measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcome indicators. Prior research indicates that Chief Nursing Officers and Executives (CNOs, CNEs) believe that evidence-based practice (EBP) is important for ensuring the quality of care, but they allocate little funding to its implementation and report it as a low priority in their healthcare system. It is not known how EBP budget investment by chief nurses affects NDNQI, CMS Core Measures, and HCAHPS indicators or key EBP attributes and nurse outcomes. This study aimed to generate evidence on the relationships among the budget devoted to EBP by chief nurses and its impact on key patient and nurse outcomes along with EBP attributes. A descriptive correlational design was used. An online survey was sent to CNO and CNE members (N = 5026) of various national and regional nurse leader professional organizations across the United States in two recruitment rounds. Data collected included CNO/CNE EBP Beliefs, EBP Implementation, and perceived organizational culture of EBP; organizational culture, structure, personnel, and resources for EBP; percent of budget dedicated to EBP; key performance measures (NDNQI, CMS Core Measures, HCAHPS); nurse satisfaction; nurse turnover; and demographic questions. Descriptive statistics were used to summarize sample characteristics. Kendall's Tau correlation coefficients were calculated among EBP budget, nursing outcome measures, and EBP measures. One hundred and fifteen CNEs/CNOs completed the survey (a 2.3% response rate). The majority (60.9%) allocated <5% of their budget to EBP, with a third investing none. An increase in EBP budget was associated with fewer patient falls and trauma, less nursing turnover, and stronger EBP culture and other positive EBP attributes. A greater number of EBP projects were also associated with better patient outcomes. Chief nurse executives and CNOs allocate very little of their budgets to EBP. When CNEs and CNOs invest more in EBP, patient, nursing, and EBP outcomes improve. System-wide implementation of EBP, which includes appropriate EBP budget allocation, is necessary for improvements in hospital quality indicators and nursing turnover.

Creating Sustainable Practice-Based Nursing Research Centers

The American Nurses Credentialing Center Magnet organizations are expected to conscientiously integrate evidence-based practice and nursing research into the fabric of clinical and operational processes. It is the expectation that Magnet organizations will have established programs of practice-based nursing research. Nurse leaders need guidance on establishing and strengthening practice-based centers of nursing research. This article summarizes key literature to create sustainable centers. The critical roles of nurse leaders and nurse researchers are reviewed. Additional evidence is provided related to meaningful design of research studies and evidence-based practice projects. The article concludes with recommendations for advancing practice-based nursing research centers.

Implementation Science Toolkit for Clinicians: Improving Adoption of Evidence in Practice.

Clinicians are often familiar with quality improvement (QI) and evidence-based practice (EBP) processes, which provides guidance into what evidence should be implemented; however, these processes do not address how to successfully implement evidence. Clinicians would benefit from a deeper understanding of implementation science, along with practical tools for how to use these principles in QI and EBP projects. We provide a brief background of the principles of implementation science, an overview of current implementation science models and a toolkit to facilitate choosing and using common implementation science strategies. In addition, the toolkit provides guidance for measuring the success of an implementation science project and a case study showing how implementation science strategies can be used successfully in clinical practice. Using an implementation science toolkit for designing, conducting, and evaluating a QI or EBP project improves the quality and generalizability of results.

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

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

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

Linking Hospitals to Communities Through Evidence-Based Practice.

Evidence-based practice (EBP) and innovation are critical to quality and improved outcomes in the acute care setting and are often driven by bedside caregiver and clinical nurse specialist collaboration. Several EBP models and frameworks exist to guide these efforts. Although existing models do not preclude external evidence and community-based stakeholders, they largely do not explicitly connect the hospital-based effort to the community either. In our experience in facilitating EBP projects within an acute care hospital in the upper Midwest, we observed multiple situations in which nurse-led EBP projects intersected with the surrounding community in multiple phases of the project. The purpose of this article is to demonstrate an explicit connection between hospital-placed EBP processes and community/population health. To illustrate this assertion, 3 exemplars of nurse-driven, hospital-placed innovation are presented. Implications for practice and research are discussed.

EBP education and skills building for leaders: An RCT to promote EBP infrastructure, process and implementation in a comprehensive cancer center.

Implementation of evidence-based practice (EBP) in healthcare remains challenging. The influence of leadership has been recognized. However, few randomized trials have tested effects of an educational and skills building intervention for leaders in clinical settings. Test effects of an EBP leadership immersion intervention on EBP attributes over time among two cohorts of leaders at a national comprehensive cancer center. A stratified, randomized, wait-list group, controlled design was conducted. Participants received the evidence-based intervention one year apart (2020, n=36; 2021, n=30) with EBP knowledge, beliefs, competencies, implementation self-efficacy, implementation behaviors, and organizational readiness measured at pre- and post-intervention, and one- and two-year follow-ups. Participants applied learnings to a specific clinical or organization priority topic. Baseline outcomes variables and demographics did not differ between cohorts except for age and years of experience. Both cohorts demonstrated significant changes in EBP attributes (except organizational readiness) post-intervention. Mixed linear modeling revealed group by time effects at 3-months for all EBP attributes except implementation behaviors and organizational readiness after the first intervention, favoring cohort 2020, with retained effects for EBP beliefs and competencies at one year. Following Cohort 2021 intervention, at 12-weeks post-intervention, implementation behaviors were significantly higher for cohort 2021. An intensive EBP intervention can increase healthcare leaders' EBP knowledge and competencies. Aligning EBP projects with organizational priorities is strategic. Follow-up with participants to retain motivation, knowledge and competencies is essential. Future research must demonstrate effects on clinical outcomes.

Translational research – New perspectives for pediatric nursing practice: Innovative strategies for change

Innovative strategies designed to address difficult pediatric nursing practice problems provide new perspectives and creative solutions to enhance pediatric nursing care for children and their families. When difficult practice problems are identified, new perspectives and creative solutions are needed. By reframing perspectives, these challenging practice problems can be addressed through innovative strategies. New perspectives are based on the outcomes of innovative nursing research, evidence-based practice and quality improvement projects.