Nursing Scientific Review Committie for Evidence Based Practice
Kathleen R. Stevens, EdD, RN, ANEF, FAAN
Abstract
The impact of evidence-based practice (EBP) has echoed across nursing practice, pedagogy, and scientific discipline. The telephone call for bear witness-based quality improvement and healthcare transformation underscores the demand for redesigning care that is effective, safe, and efficient. In line with multiple management-setting recommendations from national experts, nurses have responded to launch initiatives that maximize the valuable contributions that nurses have fabricated, can make, and will make, to fully deliver on the promise of EBP. Such initiatives include do adoption; education and curricular realignment; model and theory evolution; scientific appointment in the new fields of research; and development of a national enquiry network to study comeback. This commodity briefly describes the EBP movement and considers some of the impact of EBP on nursing do, models and frameworks, education, and research. The article concludes with word of the next big ideas in EBP, based on 2 federal initiatives, and considers opportunities and challenges as EBP continues to back up other exciting new thinking in healthcare.
Citation: Stevens, K., (May 31, 2013) "The Impact of Evidence-Based Practise in Nursing and the Next Large Ideas" OJIN: The Online Periodical of Issues in Nursing Vol. 18, No. 2, Manuscript 4.
DOI: ten.3912/OJIN.Vol18No02Man04
https://doi.org/10.3912/OJIN.Vol18No02Man04
Primal words: EBP, quality comeback, education, research network, translational scientific discipline, Institute of Medicine
Over the by decade, nurses have been part of a movement that reflects perhaps more change than any two decades combined. The recommendation that nurses pb interprofessional teams in improving delivery systems and intendance brings to the fore the necessity for new competencies, beyond testify-based practice, that are requisite as nurses transform healthcare.Directions in nursing education in the 1960s established nursing every bit an applied science. This was the entry of our profession into the age of cognition. Just in the mid-1990s did it go articulate that producing new cognition was not enough. To touch ameliorate patient outcomes, new noesis must be transformed into clinically useful forms, finer implemented across the entire care team within a systems context, and measured in terms of meaningful touch on performance and wellness outcomes. The recently-articulated vision for the futurity of nursing in the Future of Nursing study (IOM, 2011a) focuses on the convergence of knowledge, quality, and new functions in nursing. The recommendation that nurses lead interprofessional teams in improving delivery systems and care brings to the fore the necessity for new competencies, across evidence-based practice (EBP), that are requisite as nurses transform healthcare. These competencies focus on utilizing knowledge in clinical decision making and producing enquiry testify on interventions that promote uptake and employ past private providers and groups of providers.
This word highlights some of the responses and initiatives that those in the profession of nursing accept taken to maximize the valuable contributions that nurses take fabricated, tin make, and will make, to deliver on the hope of EBP. A number of selected influences of bear witness-based practice trends on nursing and nursing care quality are explored as well as thoughts well-nigh the "next large ideas" for moving nursing and healthcare forward.
The EBP Movement
EBP is aimed at hardwiring current knowledge into common care decisions to ameliorate intendance processes and patient outcomes.Evidence-based exercise holds slap-up promise for...producing the intended health outcome. Post-obit the alarming written report that major deficits in healthcare acquired significant preventable harm (IOM, 2000) a pattern for healthcare redesign was advanced in the first Quality Chasm report (IOM, 2001). A key recommendation from the nation's experts was to employ evidence-based practice. The chasm between what we know to be effective healthcare and what was practiced was to be crossed by using evidence to inform all-time practices.
Evidence-based do holds great promise for moving care to a high level of likelihood for producing the intended health outcome. The definition of healthcare quality (Box 1) is foundational to evidence-based practice.
Box 1. Definition of Quality Healthcare
Definition of Quality Healthcare
Degree to which health services for individuals and populations increase the likelihood of desired wellness outcomes and are consistent with current professional noesis (IOM 1990; 2013, para 3).
The phrases in this definition bring into focus iii aspects of quality: services (interventions), targeted health outcomes, and consistency with current knowledge (research evidence). It expresses an underlying belief that research produces the most reliable cognition nigh the likelihood that a given strategy will change a patient'due south current wellness status into desired outcomes. Alignment of services with current professional knowledge (show) is a cardinal goal in quality. The definition also calls into play the aim of reducing illogical variation in care by standardizing all care to scientific best evidence.
The EBP movement began with the characterization of the problem—the unacceptable gap between what nosotros know and what we exercise in the care of patients (IOM, 2001). In the study, Crossing the Quality Chasm (IOM, 2001), IOM experts issued the statement that yet drives today'due south quality comeback initiatives: "Betwixt the wellness care we have and the care we could take lies non but a gap but a chasm" (IOM, 2001, p. 1) and urged all health professions to bring together efforts for healthcare transformation.
Development of evidence-based practice is fueled by the increasing public and professional demand for accountability in safety and quality improvement in wellness care.A major function of the proposed solution to cross this chasm was "evidence-based practice." Experts continue to generate direction-setting IOM Chasm reports (IOM, 2003; IOM, 2008a; IOM, 2008b; IOM, 2011a); each report consistently identifies testify-based practice (EBP) as crucial in closing the quality chasm. The intended effect of EBP is to standardize healthcare practices to science and best show and to reduce casuistic variation in care, which is known to produce unpredictable health outcomes. Evolution of evidence-based practice is fueled past the increasing public and professional demand for accountability in safety and quality improvement in wellness intendance.
Leaders in the field have defined EBP as "Integration of best research evidence with clinical expertise and patient values" (Sackett et al, 2000, p. ii). Therefore, EBP unifies enquiry evidence with clinical expertise and encourages individualization of care through inclusion of patient preferences. While this early definition of EBP has been paraphrased and sometimes distorted, the original version remains well-nigh useful and is easily applied in nursing, successfully adjustment nursing with the broader field of EBP. The elements in the definition emphasize cognition produced through rigorous and systematic inquiry; the experience of the clinician; and the values of the patient, providing an enduring and encompassing definition of EBP.
The entry of EBP onto the healthcare improvement scene constituted a major paradigm shift.The EBP process has been highly applied, going beyond any applied research efforts previously fabricated in healthcare and nursing. This characteristic of EBP brought with it other shifts in the research-to-practice endeavor, including new evidence forms (systematic reviews), new roles (knowledge brokers and transformers), new teams (interprofessional, frontline, mid- and upper-management), new do cultures (just culture, healthcare learning organizations), and new fields of science to build the "evidence on testify-based practice" (Shojania & Grimshaw, 2005). The entry of EBP onto the healthcare improvement scene constituted a major paradigm shift. This shift was apparent in the way nurses began to call back about research results, the way nurses framed the context for improvement, and the mode nurses employed change to transform healthcare.
Impact on Nursing Practice
In this broad-ranging effort, some other significant player was added…the policymaker. For EBP to be successfully adopted and sustained, nurses and other healthcare professionals recognized that information technology must be adopted by individual intendance providers, microsystem and system leaders, too equally policy makers. Federal, land, local, and other regulatory and recognition actions are necessary for EBP adoption. For example, through the Magnet Recognition Programme® the profession of nursing has been a leader in catalyzing adoption of EBP and using information technology as a marker of excellence.
A contempo survey of the state of EBP in nurses indicated that, while nurses had positive attitudes toward EBP and wished to gain more knowledge and skills, they however faced significant barriers in employing information technology in do.In spite of many significant advances, nurses still have more to do to achieve EBP across the board. A recent survey of the land of EBP in nurses indicated that, while nurses had positive attitudes toward EBP and wished to gain more noesis and skills, they even so faced significant barriers in employing information technology in practice (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). One example of implementation of EBP points to the challenges of change. The bear witness-based program, Team Strategies and Tools to Enhance Performance and Patient Safe (TeamSTEPPS®) (AHRQ, 2008) carries with it proven effectiveness of reducing patient safe bug and the program is available with highly-developed training and learning materials. Yet, considering of the change necessary to fully implement and sustain the program beyond the arrangement supported by organizational civilization, a sophisticated implementation program is required before the show-based intervention is adopted across an establishment. While agency policy may be prepare, implementation and sustainment of TeamSTEPPS® remain challenging.
Impact on Nursing Models and Frameworks
Early in the EBP move, nurse scientists adult models to organize our thinking near EBP. A number of EBP models were developed past nurses to empathize various aspects of EBP. Forty-seven prominent EBP models tin be identified in the literature. These frameworks guide the design and implementation of approaches intended to strengthen bear witness-based decision making. Forty-seven prominent EBP models can be identified in the literature. One time analyzed, these models can be grouped into four thematic areas: (1) EBP, Research Utilization, and Cognition Transformation Processes; (2) Strategic/ Organizational Change Theory to Promote Uptake and Adoption of New Cognition; and (three) Noesis Exchange and Synthesis for Awarding and Inquiry (Mitchell, Fisher, Hastings, Silverman, & Wallen, 2010). Listed among models in Category one is the ACE Star Model of Knowledge Transformation (Stevens, 2004); this model is the exemplar for the nowadays discussion of the impact of EBP on nursing models and frameworks.
The ACE Star Model of Knowledge Transformation (Stevens, 2004) was developed to offer a unproblematic yet comprehensive approach to translate evidence into practice. As explained in the ACE Star Model, one arroyo to agreement the apply of EBP in nursing is to consider the nature of knowledge and noesis transformation necessary for utility and relevance in clinical determination making. Rather than having clinicians submersed in the book of research reports, a more than efficient arroyo is for the clinician to access a summary of all that is known on the topic. Likewise, rather than requiring frontline providers to master the technical expertise needed in scientific critique, their point-of-care decisions would be ameliorate supported by evidence-based recommendations in the form of clinical practice guidelines.
The ACE Star Model of Noesis Transformation highlights barriers encountered when moving evidence into do and designates solutions grounded in EBP. The model explains how various stages of knowledge transformation reduce the book of scientific literature and provide forms of cognition that tin can be direct incorporated in care and conclusion making. The ACE Star Model emphasizes crucial steps to convert one class of knowledge to the next and incorporate best inquiry evidence with clinical expertise and patient preferences thereby achieving EBP. Depicted in Figure i, the model is a five-betoken star, defining the following forms of knowledge: Indicate 1 Discovery, representing primary research studies; Signal ii Evidence Summary, which is the synthesis of all available cognition compiled into a single harmonious statement, such as a systematic review; Point 3 Translation into activeness, often referred to every bit bear witness-based clinical practice guidelines, combining the evidential base and expertise to extend recommendations; Bespeak iv Integration into practice is evidence-in-action, in which exercise is aligned to reflect best bear witness; and Bespeak five Evaluation, which is an inclusive view of the impact that the evidence-based practice has on patient health outcomes; satisfaction; efficacy and efficiency of care; and health policy.
Figure ane. ACE Star Model of Cognition Transformation
Copyright Stevens 2004. Reproduced with permission.
Quality comeback of healthcare processes and outcomes is the goal of knowledge transformation. Important new knowledge resources have been developed and advanced owing to the EBP movement. The importance of Point ii and Point 3 forms of knowledge has been underscored by several contempo reports on the role of systematic reviews (IOM, 2008a; IOM, 2008b; IOM, 2011b) and clinical practice guidelines (IOM, 2008a; IOM, 2008b , IOM, 2011c) in "knowing what works in healthcare." As an of import new grade of cognition, systematic reviews are characterized as the central link between research and clinical conclusion making (IOM, 2008). Too, the part of clinical practice guidelines is to guide do (IOM, 2008). Important new noesis resource have been developed and advanced attributable to the EBP movement. While resource were available for Point i, only recently accept resources been developed for the knowledge forms on Indicate 2, 3, four, and 5 of the Model. These resources are outlined in Table 1.
| Table 1. Resource for Forms of Noesis in the Star Model. | |
| Form of Cognition | Clarification of Resources |
| Point one-Discovery | Bibliographic Databases such as CINAHL-provide unmarried research reports, in most cases, multiple reports. |
| Betoken two-Evidence Summary | Cochrane Collaboration Database of Systematic Reviews-provides reports of rigorous systematic reviews on clinical topics. See world wide web.cochrane.org/ |
| Point 3-Translation into Guidelines | National Guidelines Clearinghouse-sponsored by AHRQ, provides online access to evidence-based clinical practice guidelines. See www.guideline.gov |
| Point four-Integration into Practice | AHRQ Health Intendance Innovations Exchange-sponsored by AHRQ, provides profiles of innovations, and tools for improving care processes, including adoption guidelines and information to contact the innovator. Come across http://innovations.ahrq.gov/ |
| Point 5-Evaluation of Procedure and Outcome | National Quality Measures Clearinghouse-sponsored by AHRQ, provides detailed data on quality measures and measure sets. Encounter http://qualitymeasures.ahrq.gov/ |
Impact on Nursing Education
Following the influential Crossing the Quality Chasm report (IOM, 2001), experts emphasized that the preparation of health professionals was crucial to bridging the chasm (IOM, 2003). The Wellness Professions Education report (IOM, 2003) declared that current educational programs practise not adequately prepare nurses, physicians, pharmacists or other health professionals to provide the highest quality and safest health care possible. The conclusion was that teaching for all health professions were in need of "a major overhaul" to set wellness professions with new skills to assume new roles (IOM, 2003). This overhaul would require changing way that wellness professionals are educated, in both bookish and exercise settings. Programs for basic preparation of health professionals were to undergo curriculum revision in guild to focus on evidence-based quality improvement processes. Also, professional person development programs would demand to become widely bachelor to update skills of those professionals who were already in practice. Leaders in all health disciplines were urged to come together in an effort for clinical teaching reform that addresses five core competencies essential in bridging the quality chasm: All wellness professionals should be educated to evangelize patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice, quality comeback approaches, and informatics (IOM, 2003). Table 4 presents details of each competency.
| Table 4. Core Competencies for Health Professions |
From: IOM Health Professions Education, 2003, p. 4. |
From this core set, IOM urged each profession to develop details and strategies for integrating these new competencies into education. With a focus on employing evidence-based practise, nurses established national consensus on competencies for EBP in nursing in 2004 and extended these in 2009 (Stevens, 2009). The ACE Star Model served as a framework for identifying specific skills requisite to employing EBP in a clinical role. Through multiple iterations, an adept console generated, validated, and endorsed competency statements to guide pedagogy programs at the basic (associate and undergraduate), intermediate (masters), and doctoral (advanced) levels in nursing. Between ten and 32 specific competencies are enumerated for each of four levels of nursing education which were published in Essential Competencies for EBP in Nursing (Stevens, 2009). These competencies address central skills of knowledge direction, accountability for scientific ground of nursing practise; organizational and policy change; and development of scientific underpinnings for EBP (Stevens, 2009).
A measurement musical instrument was developed from these competencies, chosen the ACE EBP Readiness Inventory (ACE-ERI). The ACE-ERI quantifies the individual's confidence in performing EBP competencies. The ACE-ERI exhibits strong psychometric properties (reliability, validity, and sensitivity) and is widely used in clinical and instruction settings to assess nurses' readiness for employing EBP and measuring touch on of professional development programs (Stevens, Puga, & Low, 2012). The ACE Star Model, competencies, and ERI accept been adopted into practice settings as nurses strategize to employ EBP. These resource have also been incorporated into educational settings as programs are revised to include EBP skills.
Curricular efforts were also underway. To stimulate curricular reform and kinesthesia development, the IOM suggested that oversight processes (such every bit accreditation) exist used to encourage adoption of the five core competencies. Initiatives that followed included the new program standards established by the American Clan of Colleges of Nursing, crossing undergraduate, masters, and doctoral levels of educational activity (AACN, 2013). The AACN standards underscored the necessity for nurses to focus on the systems of care as well on the evidence for clinical decisions. This systems thinking is crucial to effect the changes that are part of employing EBP.
Some other curricular initiative became known as Quality and Prophylactic Education in Nursing Institute (QSEN) (QSEN Institute, 2013). Through multiple phases, this projection developed a website that serves as a central repository of information on core QSEN competencies, knowledge, skill, attitudes, teaching strategies, and faculty development resources designed to prepare nurses to engage in quality and safety.
Educating nurses in EBP competencies was catapulted forward with the publication ofEducational activity IOM. Educating nurses in EBP competencies was catapulted forward with the publication of Teaching IOM (Finkleman & Kenner, 2006). While the materials presented were in existence in other professional person literature, the book added great value by synthesizing what was known into 1 publication. This resources was accessible to every faculty member offer teaching strategies and learning resources for incorporating the IOM competencies into curricula across the nation. The resource continues to be updated and expanded through subsequent editions and versions (Finkleman & Kenner, 2013a; 2013b). The strength of these resources is that the approaches and strategies remain closely aligned with the Institute of Medicine'south continuing progress toward ameliorate health care. This shut alignment reflects the appreciation that nursing must be function of this solution to effect the desired changes; and remaining in the mainstream with other health professions rather than splintering providers into discipline-axial paradigms.
Impact on Nursing Inquiry
Nascent fields are emerging to empathise how to increase effectiveness, efficiency, safety, and timeliness of healthcare; how to amend health service delivery systems; and how to spur operation comeback.Nursing enquiry has been impacted past recent far-reaching changes in the healthcare research enterprise. Never earlier in healthcare history has the focus and formalization of moving prove-into-practice been as abrupt as is seen in today's inquiry on healthcare transformation efforts. Nascent fields are emerging to empathize how to increase effectiveness, efficiency, condom, and timeliness of healthcare; how to improve health service delivery systems; and how to spur performance comeback. These emerging fields include translational and improvement science, implementation research, and wellness delivery systems science.
Investigation into uptake of evidence-based practice is one of the fields that has deeply affected the paradigm shift and is woven into each of the other fields. Investigation into EBP uptake is equivalent to investigating Star Point 4 (integration of EBP into do). Several notable federal grant programs take evolved to foster research that produces the evidential foundation for effective strategies in employing EBP. Amidst the new enquiry initiatives are the Clinical Translational Science Awards and the Patient-Centered Outcomes grants.
Clinical and Translational Scientific discipline Awards
When the public cry for improved care escalated, rapid movement of results into intendance was brought into sharper focus in healthcare research. The National Institutes of Health (NIH), including the National Institute for Nursing Enquiry (NINR), adult the Clinical Translational Scientific discipline Honour (CTSA) program to speed research-to-practice by redesigning the manner healthcare research is conducted (Zerhouni, 2005). The term, translational science, was coined, and the definition was provided by NIH (2010): "Translational research includes ii areas of translation. 1 ["T1"] is the procedure of applying discoveries generated during research in the laboratory, and in preclinical studies, to the evolution of trials and studies in humans. The second area of translation ["T2"] concerns enquiry aimed at enhancing the adoption of all-time practices in the community. The comparative effectiveness of prevention and handling strategies are [sic] also an important function of translational science" (Section I, para 2).
Nurses are involved in each of the sixty CTSAs that were funded across the nation...Nurse scientists have been significant leaders in the CTSA programme, conducting translational enquiry across these two areas. Nurses are involved in each of the 60 CTSAs that were funded across the nation, contributing from small roles and large roles, ranging from advisor and collaborator to master investigator. Equally office of the CTSAs, nurse scientists conduct bones research and applied inquiry, adding significantly to the interprofessional perspectives of the scientific discipline. In relation to EBP, nurses are valued contributors to the "T2" finish of the continuum of translational science, applying skills in mixed methods and systems settings.
Patient-Centered Outcomes Research
Equally evidence mounted on standard medical metrics...it was noted that metrics and outcomes of particular interest to patients and families... were understudied.Another recent and swooping change in healthcare research emerged with a focus on patient-centered outcomes research (PCOR). As testify mounted on standard medical metrics (mortality and morbidity), it was noted that metrics and outcomes of detail interest to patients and families (such as quality of life) were understudied. In 2010, attention was drawn to the need to produce show on patient-centered outcomes from the perspective of the patient. Congress founded and heavily funded the newly-formed Patient-Centered Outcomes Enquiry Plant (PCORI) with the following mission: "The Patient-Centered Outcomes Research Plant (PCORI) helps people make informed health care decisions, and improves wellness care delivery and outcomes, by producing and promoting high integrity, evidence-based information that comes from inquiry guided by patients, caregivers and the broader health care community" (PCORI, 2013, para. 1).
Likewise, some of the most contempo calls for inquiry from the Agency for Healthcare Research and Quality (AHRQ) are also focusing on PCOR. These calls encourage early and meaningful appointment of patients and other stakeholders in stating the enquiry question, conducting the study, and interpreting results (AHRQ, 2013). This new direction in healthcare research will produce evidence that is co-investigated by patients and families in partnership with health scientists, increasing relevance so that EBP reflects the patient's viewpoint.
The Next Big Ideas
Ii additional federal initiatives exemplify what may be called the next big ideas in EBP—each underscoring evidence-based quality improvement. The initiatives call for meliorate use of the knowledge that may be gained from quality comeback efforts. Both initiatives emanate from the NIH and both focus on generating show needed to brand systems improvements and transform healthcare. The offset is NIH's expansion of the program on Dissemination and Implementation (D&I) science; the second is the evolution of the research network, the Improvement Science Research Network (ISRN).
NIH Dissemination & Implementation (D&I) Grants
A call for increased emphasis on implementation of evidence-based practices brought forth a federal funding program. In January of 2013, the NIH initiative in dissemination and implementation was expanded across 14 institutes, including NINR. In this phone call for research proposals, implementation is defined as "the utilize of strategies to adopt and integrate evidence-based health interventions and modify do patterns within specific settings" (NIH, 2013, Department I, para 11). This research initiative volition add to our agreement of how to create, evaluate, report, dissemination, and integrate evidence-based strategies to better health (Brownson, Colditz, & Proctor, 2012). Because of the central role that nurses play across all healthcare settings and clinical microsystems, enquiry in this field is highly relevant to the profession.
D&I research offers nurses opportunities to guide health care transformation at multiple level...This field of science moves beyond the individual provider as the unit of analysis and focuses on groups, wellness systems, and the customs. D&I research offers nurses opportunities to guide health care transformation at multiple levels, thereby addressing recommendation from the Hereafter of Nursing. For example, one emphasis in the field is discovering and applying the show for the most constructive ways to speed adoption of evidence-based guidelines across all health intendance professionals in the clinical unit and in the agency. To date, nurse scientists are minimally engaged in D&I research. A recent survey of seven years of NIH projects indicated that simply four percent of these were awarded to nurse scientists (Tinkle, Kimball, Haozous, Shuster, & Meize-Grochowski, 2013).
Improvement Science Research Network
The overriding goal of improvement scientific discipline is to ensure that quality comeback efforts are based as much on show as the best practices they seek to implement.Continuing piece of work with using the ACE Star Model every bit a framework laid a pathway to one of the "next big ideas:" to move from EBP to the report of strategies for achieving EBP (Stevens, 2012). In many instances, studies about single innovations on Star Point 4 were frequently non rigorous or broad enough to produce credible and generalizable noesis (Berwick, 2008). As a new field, improvement science focuses on generating testify about employing evidence-based exercise, providing enquiry prove to guide management decisions in evidence-based quality comeback. The overriding goal of improvement science is to ensure that quality improvement efforts are based equally much on bear witness as the best practices they seek to implement.
Recognizing that pockets of excellence in safety and effectiveness exist, at that place is concern that local cases of success in translating research into practice are oftentimes difficult to replicate or sustain over time. Factors that make a alter improvement work in one setting versus another are largely unknown. To make full this gap, the Comeback Science Research Network (ISRN) was adult (Stevens, 2010). The ISRN is an open inquiry network for the study of improvement strategies in healthcare. The national network offers a virtual collaboratory in which to written report systems improvements in such a way that lessons learned from innovations and quality comeback efforts can exist spread for uptake in other settings. The ISRN was developed in response to an NIH call for projects that build infrastructures to advance new fields of scientific discipline.
The ISRN supports rigorous testing of improvement strategies to determine whether, how, and where an intervention for change is constructive. The following shortcomings in research regarding comeback alter strategies take been noted: studies do non yield generalizable information because they are performed in a single setting; the improvement intervention is inadequately described and impact imprecisely measures; information almost sustainability of change is non produced; contexts of implementation are not accounted for; price or value is not estimated; and such research is seldom systematically planned (IOM, 2008b).
The master goal of the network is to determine which improvement strategies work every bit nosotros strive to assure effective and safe patient care. Through this national research collaborative, rigorous studies are designed and conducted through investigative teams. Foundational to the network is the virtual collaboratory, fashioned to comport multi-site studies and designed around interprofessional academic-practice partnerships in research. The ISRN offers scientists and clinicians from across the nation opportunities to direct engage in conducting studies. "No hospital too small, no study as well big" is one of the guiding principles of ISRN collaboration (ISRN Resource List, n.d., para. 28). ISRN Enquiry Priorities were developed via stakeholder and expert console consensus and are organized into four broad categories: transitions in intendance; loftier performing clinical microsystems; testify-based quality improvement; and organizational civilisation (ISRN, 2010). The research collaboratory concept has proven its capacity to conduct multi-site studies and is open to whatever investigator or collaborator in the field.
The new NIH D&I grant resources and the ISRN collaboratory are "the next big ideas" in advancing EBP today. These will provide the scientific foundation for the quickly expanding efforts to brand healthcare improve. Nurses will take advantage of these EBP advances to address opportunities and challenges.
Opportunities and Challenges
...the story of EBP in nursing is now long, with many successes, contributors, leaders, scientists, and enthusiasts. Much has been done to make an impact; much remains to be accomplished.From this admittedly selective overview of EBP, information technology is seen that the story of EBP in nursing is now long, with many successes, contributors, leaders, scientists, and enthusiasts. Much has been done to make an impact; much remains to exist accomplished. Opportunities and challenges exist for clinicians, educators, and scientists.
Those leading clinical practice take willing partners from the academy for discovering what works to meliorate health care. Such evidence to guide clinical management decisions is long overdue (Yoder-Wise, 2012). While at that place are benefits to both as the evidence is gathered and applied, the true benefit goes to the patient. Clinical leaders take unprecedented opportunity to step forward to transform healthcare from a systems perspective, focusing on EBP for clinical effectiveness, patient date, and patient safety.
Those leading didactics accept peachy advantages offered from a wide diverseness of educational resources for EBP. The rich resources offering students a chance to meaningfully connect their emerging competencies with clinical needs for best practices in clinical and microsystem changes. As they emerge from formal education, students will see corking enthusiasm for employing EBP in today'due south clinical environments.
Those leading nursing scientific discipline have access to new funding opportunities to develop innovative programs of enquiry in evidence-based quality comeback, implementation of EBP, and the science of improvement. Readiness of the clinical setting for academic-practise enquiry partnerships brings with information technology advantageous access to clinical populations and settings and an eagerness for utilization of the research results.
The challenges for moving EBP forward spring from two sources: nurses becoming powerful leaders in interprofessional groups and nurses becoming powerful influencers of change. Therefore, adopting the following habits agree hope for moving u.s.a. ahead:
- Redesigning and/or investigating the redesign of healthcare systems through creativity and mastery of teamwork.
- Persistence in educating the time to come workforce, and retooling the electric current workforce, with awareness, skills, and power to improve the systems of care.
- Laying aside comfortable programs of research and picking upward programs of systems enquiry.
- Insistence on multiple perspectives and sound bear witness for transforming healthcare.
The nursing profession remains key to the interdisciplinary and discipline-specific changes necessary to reach care that is effective, prophylactic, and efficient. New in our vernacular and skill set are systems thinking, microsystems alter, loftier reliability organizations, team-based care, transparency, innovation, translational and implementation scientific discipline, and, yes, still bear witness-based practice. Let us move swiftly to make these new ideas and skills commonplace.
Acknowledgment
Portions of this work were supported by the National Institutes of Health, National Institute of Nursing Research NIH (1RC2 NR011946-01, PI K. Stevens), and NIH CTSA (UL1TR000149, PI R. Clark).
Correction Detect
On September three, 2013, the Acknowledgment was modified from the original publication appointment of May 31, 2013. Additional information has been added at the request of the author.
Author
Kathleen R. Stevens, EdD, RN, ANEF, FAAN
Email: STEVENSK@uthscsa.edu
Dr. Stevens is STTI Episteme Laureate, Professor and Director of the Academic Heart for Show-Based Exercise (ACE) and Comeback Scientific discipline Research Network (ISRN) in the University of Texas Health Science Center School of Nursing San Antonio. She holds the UT Organisation Chancellor'south Health Fellowship in interprofessional health delivery science. Her multi-site research on squad collaboration and frontline engagement in quality comeback is conducted through the national collaboratory, the ISRN.
References
Agency for Healthcare Research and Quality (AHRQ). (2008). TeamSTEPPS national implementation project 2008. Retrieved from: http://teamstepps.ahrq.gov/
Agency for Healthcare Inquiry and Quality (AHRQ). (2013). Funding and grants. Retrieved from: www.ahrq.gov
American Clan of Colleges of Nursing (AACN). (2013). Essentials series. Retrieved from: www.aacn.nche.edu/education-resource/essential-serial
Berwick, D.M. (2008). The science of improvement. Journal of the American Medical Association, 299(x), 1182-1184.
Brownson, R.C., Colditz, Thou.A., & Proctor, Due east.Thou. (2012). Dissemination and implementation research in health: Translating science to practice. New York: Oxford Academy Press, Inc.
Finkelman, A & Kenner, CA. (2006). Teaching IOM: Implications of the IOM reports for nursing education. Washington, DC: American Nurses Association.
Finkelman, A & Kenner, CA. (2013a). (iiird Ed). Educational activity IOM: Implications of the IOM reports for nursing education. Washington, DC: American Nurses Association.
Finkelman, A & Kenner, CA. (2013b). Learning IOM: Implications of the IOM reports for nursing pedagogy. Washington, DC: American Nurses Association.
Comeback Science Research Network (ISRN) (north.d.) ISRN resource list. Retrieved from www.isrn.net/ISRNResourceList
Improvement Science Enquiry Network (ISRN). (2010). Research priorities. Retrieved from www.isrn.net/inquiry
Constitute of Medicine (IOM). (1990). Medicare: A strategy for quality assurance. (Lohr, KN, Ed.). Washington, DC: National University Printing.
Institute of Medicine. (2000). To err is homo: Building a safer health system. Washington, DC: National Academy Press.
Plant of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Committee on Quality of Wellness Care in America, Constitute of Medicine. Washington DC: National Academies Press.
Establish of Medicine. (2003). Greiner, Air-conditioning & Knebel, E (Eds.). Health professions education: A bridge to quality. Washington, DC: National Academies Printing.
Found of Medicine. (2008a). Knowing what works in health care: A roadmap for the nation. Washington, DC: National Academies Press.
Institute of Medicine (IOM). (2008b). Training the workforce in quality improvement and quality improvement research. IOM Forum Workshop. Washington, DC: National Academies Printing.
Institute of Medicine. (2011a). The future of nursing: Leading change, advancing health [prepared by Robert Forest Johnson Foundation Committee Initiative on the Future of Nursing]. Washington, DC: National Academies Press.
Institute of Medicine. (2011b). Finding what works in wellness care: Standards for systematic reviews. [Committee on Standards for Systematic Reviews of Comparative Effective Research; Board on Wellness Care Services]. Washington, DC: National Academies Printing.
Institute of Medicine. (2011c). Clinical practice guidelines we tin can trust [Committee on Standards for Developing Trustworthy Clinical Practice Guidelines]. Washington, DC: National Academies Printing. Retrieved from: www.iom.edu/Reports/2011/Clinical-Practice-Guidelines-We-Can-Trust.aspx.
Institute of Medicine. (2013). Announcement. Crossing the quality chasm: The IOM health intendance quality initiative. Retrieved from: www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx
Mitchell, Southward.A., Fisher, C.A., Hastings, CE, Silverman, L.B., Wallen, G.R. (2010). A thematic analysis of theoretical models for translational science in nursing: Mapping the field. Nursing Outlook, 58(half-dozen), 287-300.
National Institutes of Health (NIH). (2010). Institutional clinical and translational science award (U54)Retrieved from: http://grants.nih.gov/grants/guide/rfa-files/RFA-RM-10-001.html#SectionI
National Institutes of Health (NIH). (2013). Dissemination and implementation research in health. PAR x-038. Retrieved from: http://grants.nih.gov/grants/guide/pa-files/PAR-10-038.html
Patient-Centered Outcomes Research Establish (PCORI). (2013). Mission and vision. Retrieved from: www.pcori.org/well-nigh/mission-and-vision/
Quality and Safety Instruction in Nursing Institue (QSEN). (2013). About QSEN. Retrieved from http://qsen.org/near-qsen/
Shojania, Yard.G., & Grimshaw, J.M. (2005). Evidence-based quality improvement: The state of the science. Health Affairs (Millwood), 24(one), 138-150.
Stevens, K.R. (2004). ACE star model of knowledge transformation. Bookish Heart for Evidence-based Practice. Academy of Texas Wellness Scientific discipline Heart San Antonio. www.acestar.uthscsa.edu
Stevens, Chiliad.R. (2009). Essential prove-based practise competencies in nursing. (2nd Ed.) San Antonio, TX: Academic Center for Evidence-Based Practice (ACE) of University of Texas Health Science Center San Antonio.
Stevens, K.R. (2012). Delivering on the hope of EBP. Nursing Management, 3(iii). Philadelphia: Lippincott, Williams & Wilkins, Inc.
Stevens, K.R., Puga, F., & Low, V. (2012). The ACE-ERI: An instrument to measure EBP readiness in student and clinical populations. Retrieved from: www.acestar.uthscsa.edu/institute/su12/documents/ace/8%20The%20ACE-ERI%twenty%20Instrument%20to%20Benchmark.pdf
Tinkle, K., Kimball, R., Haozous, E.A., Shuster, G., & Meize-Grochowski, R. (2013). Broadcasting and implementation research funded by the U.s.a. National Institutes of Health, 2005–2012. Nursing Enquiry and Practise, Article ID 909606, 15 pages.
Yoder-Wise, P. (2012). The complex challenges of administrative research for the futurity. JONA, 42(five), 239-241.
Zerhouni, East.A. (2005). Translational and clinical science—time for a new vision. New England Journal of Medicine, 353(15), 1621-3.
© 2013 OJIN: The Online Journal of Issues in Nursing
Commodity published May 31, 2013
Related Articles
- Simulation in Nursing Exercise: The Impact on Patient Care
Michelle Aebersold, PhD, RN; Dana Tschannen, PhD, RN (May 31, 2013) - Hospital-Based Autumn Program Measurement and Comeback in High Reliability Organizations
Patricia A. Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAANP; Susan Five. White, PhD, RN, CPHQ, FNAHQ, NEA-BC (May 31, 2013) - Nursing Control Over Practice and Teamwork
Jessica Castner, PhD, RN, CEN; Diane J. Ceravolo, MS, RN; Kelly Foltz-Ramos, MS, RN; Yow-Wu Bill Wu, PhD (May 31, 2013) - Nursing Intellectual Capital Theory: Implications for Research and Do
Christine L. Covell PhD, RN; Souraya Sidani, PhD (May 31, 2013) - The Impact of Emerging Technology on Nursing Care: Warp Speed Alee
Carol Huston, MSN, DPA, FAAN (May 31, 2013) - The Value of Library and Information Services in Nursing and Patient Care
Joanne Gard Marshall, PhD, MLS, MHS; Jennifer Morgan, PhD; Mary Lou Klem, PhD MLIS; Cheryl Thompson, MSIS; Amber Wells, MA (August 18, 2014) - Toward an Understanding of Wisdom in Nursing
Susan A. Matney, MSN, RN-C, FAAN; Kay Avant, PhD, RN, FNI, FAAN; Nancy Staggers, PhD, RN, FAAN (Oct 30, 2015) - Benefits of On-Site Clinics
Louise C. O'Keefe, PhD, CRNP; Faye Anderson, DNS, RN, NEA-BC (March 20, 2017) - Medication Adherence in a Cardiac Ambulatory Setting: The Claiming Continues
Jayne Rosenberger, BSN, RN, CCRN; Esther Bernhofer, PHD, RN-BC, CPE; Susan McCrudden, BSN, RN; & Rosa Johnson, MS, RN-BC, BA, BSN, OCN (September 27, 2017) - Lessons Learned and Insights Gained: A Regulatory Analysis of the Impacts, Challenges, and Responses to COVID-nineteen
David C. Benton, PhD, RN, FRCN, FAAN; Maryann Alexander, PhD, RN, FAAN; Rebecca Fotsch, JD; Nicole Livanos, JD, MPP (Baronial 12, 2020)
joneshamakfame1944.blogspot.com
Source: https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.htmlAmerican
:max_bytes(150000):strip_icc()/slow-grilled-beef-ribs-335856-diana-rattray-2022-5b883dee1edc4ce190be4710178120a5.jpg)
Post a Comment for "Nursing Scientific Review Committie for Evidence Based Practice"