What are the factors of organisational culture in health care settings
that act as barriers to the implementation of evidence-based practice? A
scoping review.
Williams, Brett; Perillo, Samuel; Brown, Ted;
Nurse Education Today, 2015 Feb; 35 (2): e34-41.
Abstract: Summary Background The responsibility to implement
evidence-based practice (EBP) in a health care workplace does not fall solely
on the individual health care professional. Organisational barriers relate to
the workplace setting, administrational support, infrastructure, and facilities
available for the retrieval, critique, summation, utilisation, and integration
of research findings in health care practices and settings. Objective Using a
scoping review approach, the organisational barriers to the implementation of
EBP in health care settings were sought. Method This scoping review used the
first five of the six stage methodology developed by Levac et al. (2010). The
five stages used are: 1) Identify the research question; 2) identify relevant
studies; 3) study selection; 4) charting the data; and 5) collating,
summarising and reporting the results. The following databases were searched
from January 2004 until February 2014: Medline, EMBASE, EBM Reviews, Google
Scholar, The Cochrane Library and CINAHL. Results Of the 49 articles included
in this study, there were 29 cross-sectional surveys, six descriptions of
specific interventions, seven literature reviews, four narrative reviews, nine
qualitative studies, one ethnographic study and one systematic review. The
articles were analysed and five broad organisational barriers were identified.
Conclusions This scoping review sought to map the breadth of information
available on the organisational barriers to the use of EBP in health care
settings. Even for a health care professional who is motivated and competent in
the use of EBP; all of these barriers will impact on their ability to increase
and maintain their use of EBP in the workplace.
Back to Basics: Implementing Evidence-Based Practice.
Spruce, Lisa;
AORN Journal, 2015; 101 (1): 106-12.
Abstract: As health care transitions from volume-based care to
value-based care, it is imperative that perioperative nurses implement
evidence-based practices that support effective care. Implementing
evidence-based practice is a challenge but improves patient outcomes,
standardizes care, and decreases patient care costs. Understanding how care
interventions work and how to implement them is important to compete in today's
health care market. This "Back to Basics" article discusses how to
identify, review, and appraise research; make recommendations to implement new
practices; evaluate the outcomes of the implementations; and make necessary
changes to facilitate evidence-based practice.
Development of Evidence-Based Remote Telemetry Policy Guidelines for a
Multifacility Hospital System.
George, Karen J.; Walsh-Irwin, Colleen; Queen, Caleb; Vander Heuvel,
Kimberly; Hawkins, Carrie; Roberts, Susan;
Dimensions of Critical Care Nursing, 2015 Jan-Feb; 34 (1): 10-8.
Abstract: Over 10 years ago, the standards for cardiac monitoring were
set forth by the Councils on Cardiovascular Nursing, Clinical Cardiology, and
Cardiovascular Disease in the Young. The standards were endorsed by the
International Society of Computerized Electrocardiology and the American
Association of Critical-Care Nurses. The American Heart Association printed the
standards as an American Heart Association Scientific Statement. The standards
provided direction related to remote telemetry monitoring to acute care
hospitals. Since the standards were published, remote monitoring of cardiac
patients has increased dramatically prompting research and literature related
to appropriate utilization. Appropriate and safe telemetry monitoring requires
clearly written evidence-based facility policies. This article describes the
process whereby a team of Veterans Hospital Administration nurses from across
the country reviewed 70 remote telemetry policies representing 75 Veterans
Hospital Administration hospitals for clarity, consistency, and congruency to
existing levels of evidence found in the literature. This article describes the
processes, successes, and challenges of compiling an evidence-based remote
telemetry policy guideline.
Evidence-Based Practice to Improve Outcomes for Late Preterm Infants.
Baker, Brenda;
JOGNN: Journal of Obstetric, Gynecologic & Neonatal Nursing, 2015
Jan; 44 (1): 127-34
Abstract: Infants born between 34 weeks 0 days to 36 weeks 6 days
gestation have been identified as late preterm infants (LPIs) and account for
70% of preterm births and 9% of all births. The rise in elective deliveries in
the past decade is believed to have contributed to the number of late preterm
births. An interprofessional team including labor and delivery, neonatal
intensive care, and postpartum care providers collaborated to address this
issue at an urban academic medical center.
Evidence-based nursing. Harnessing technology to promote
patient-centered care.
Fisher, Cheryl A.; Feigenbaum, Kathryn;
Nursing Management, 2015 Jan; 46 (1): 14-5.
Implementing evidence-based care for patients with obstructive sleep
apnea.
Bourdon, Leslie;
AORN Journal, 2014; 100 (6): C5-7.
Nursing Journal Clubs: A Literature Review on the Effective Teaching
Strategy for Continuing Education and Evidence-Based Practice.
Lachance, Carly;
Journal of Continuing Education in Nursing, 2014 Dec; 45 (12): 559-65.
Abstract: Background: This literature review on nursing journal clubs
evaluates the efficacy of the teaching strategy within the clinical setting.
Method: Peer-reviewed articles were retrieved using an online journal database.
Inclusion criteria incorporated information on efficacy of the teaching
strategy, evidence-based practices, and continuing education as they related to
nursing journal club initiatives. Results: The literature cited numerous
benefits and proved to be in favor of nursing journal clubs. The most common
benefits found were nurses remaining abreast of current research, skill
development in reading and critically appraising research, and incorporation of
evidence-based practices to patient care. Due to the self-motivated and
voluntary nature of this teaching strategy, a limitation commonly identified
was lack of participation, and further research on this limitation often was
suggested. Conclusion: Nursing journal clubs proved to be an effective teaching
strategy, a finding that remains consistent with the medical pioneers of the
movement. J Contin Educ Nurs. 2014;45(12):559-565.
Evidence Synthesis and Its Role in Evidence-Based Health Care.
Pearson, Alan;
Nursing Clinics of North America, 2014 Dec; 49 (4): 453-60.
Promoting patient safety with evidence-based management.
Hastings, Clare;
Nursing Management, 2014 Dec; 45 (12): 11-3.
Implementing Evidence-Based Medication Safety Interventions on a
Progressive Care Unit.
Williams, Tyeasha; King, Melissa W.; Thompson, Julie A.; Champagne,
Mary T.;
American Journal of Nursing, 2014 Nov; 114 (11): 53-62.
Abstract: While preparing medications in complex health care
environments, nurses are frequently distracted or interrupted, which can lead
to medication errors that may adversely affect patient outcomes. This pilot
quality improvement project, which took place in a 32-bed surgical progressive
care unit in an academic medical center, implemented five medication safety
interventions designed to decrease distractions and interruptions during
medication preparation: nursing staff education, use o f a medication safety
vest, delineation of a no-interruption zone, signage, and a card instructing
nurses how to respond to interruptions. Four types of distractions and
interruptions decreased significantly between the two-month preimplementation
and two-month postimplementation periods: those caused by a physician, NR o r
physician assistant; those caused by other personnel; phone calls and pages
placed or received by the nurse during medication administration; and
conversation unrelated to medication administration that involved the nurse or
loud nearby conversation that distracted the nurse. The total number of
reported adverse drug events also decreased from 10 to four, or by 60%. Thus,
medication safety interventions may help decrease distractions and
interruptions in high-acuity settings.
Improving the Culture of Evidence-Based Practice at a Magnet® Hospital.
Kaplan, Louise; Zeller, Edna; Damitio, Diane; Culbert, Sarah; Bayley,
K. Bruce;
Journal for Nurses in Professional Development, 2014 Nov-Dec; 30 (6):
274-80.
Role of the Acute Care Nurse in Managing Patients With Heart Failure
Using Evidence-Based Care.
Paul, Sara; Hice, Amber;
Critical Care Nursing Quarterly, 2014 Oct-Dec; 37 (4): 357-76.
Abstract: Acute heart failure is a major US public health problem,
accounting for more than 1 million hospitalizations each year. As part of the
health care team, nurses play an important role in the evaluation and
management of patients presenting to the emergency department with acute
decompensated heart failure. Once acute decompensation is controlled, nurses
also play a critical role in preparing patients for hospital discharge and
educating patients and caregivers about strategies to improve long-term
outcomes and prevent future decompensation and rehospitalization. Nurses’
assessment skills and comprehensive knowledge of acute and chronic heart
failure are important to optimize patient care and improve outcomes from
initial emergency department presentation through discharge and follow-up. This
review presents an overview of current heart failure guidelines, with the goal
of providing acute care cardiac nurses with information that will allow them to
better use their knowledge of heart failure to facilitate diagnosis,
management, and education of patients with acute heart failure.
Preventing Ventilator-Associated Events: Complying With Evidence-Based Practice.
Munaco, Sandra S.; Dumas, Bonnie; Edlund, Barbara J.;
Critical Care Nursing Quarterly, 2014 Oct-Dec; 37 (4): 384-92.
Abstract: The leading cause of death due to health care-associated
infections is ventilator-associated pneumonia (VAP). The lack of clarity in the
definition of VAP has made it difficult to execute and evaluate the
effectiveness of prevention strategies. Beginning in 2013, hospitals were
expected to implement a new surveillance definition algorithm to identify
ventilator-associated events (VAEs). The Institute for Healthcare Improvement
recommended the use of the Ventilator Care Bundle as part of an initiative to
decrease the incidence of VAP. This article outlines the results of a quality
improvement project that was conducted to address this recommendation, improve
current staff knowledge, identify gaps in practice, and determine the rate of
compliance with prevention strategies. The major findings of this project also
exposed limitations of the electronic medical record system, and suggested
enhancements, which would promote the VAP Bundle initiatives, facilitate
documentation, and permit straightforward data collection.
Systematic review of instruments for measuring nurses' knowledge,
skills and attitudes for evidence-based practice.
Leung, Kat; Trevena, Lyndal; Waters, Donna;
Journal of Advanced Nursing, 2014 Oct; 70 (10): 2181-95.
Abstract: Aim To identify, appraise and describe the characteristics of
instruments for measuring evidence-based knowledge, skills and/or attitudes in
nursing practice. Background Evidence-based practice has been proposed for
optimal patient care for more than three decades, yet competence in
evidence-based practice knowledge and skills among nurse clinicians remains
difficult to measure. There is a need to identify well-validated and reliable
instruments for assessing competence for evidence-based practice in nursing.
Design Psychometric systematic review. Data Sources The MEDLINE, EMBASE,
CINAHL, ERIC, CDSR, All EBM reviews and PsycInfo databases were searched from
1960-April 2013; with no language restrictions applied. Review Methods Using
pre-determined inclusion criteria, three reviewers independently identified
studies for full-text review, extracting data and grading instrument validity
using a Psychometric Grading Framework. Results Of 91 studies identified for
full-text review, 59 met the inclusion criteria representing 24 different
instruments. The Psychometric Grading Framework determined that only two
instruments had adequate validity - the Evidence Based Practice Questionnaire
measuring knowledge, skills and attitudes and another un-named instrument
measuring only EBP knowledge and attitudes. Instruments used in another nine
studies were graded as having 'weak' validity and instruments in the remaining
24 studies were graded as 'very weak'. Conclusion The Evidence Based Practice
Questionnaire was assessed as having the highest validity and was the most practical
instrument to use. However, the Evidence Based Practice Questionnaire relies
totally on self-report rather than direct measurement of competence suggesting
a need for a performance-based instrument for measuring evidence-based
knowledge, skills and attitudes in nursing.
$trategies for Searching and Managing Evidence-Based Practice
Resources.
Robb, Meigan; Shellenbarger, Teresa;
Journal of Continuing Education in Nursing, 2014 Oct; 45 (10): 461-6.
Abstract: Evidence-based nursing practice requires the use of effective
search strategies to locate relevant resources to guide practice change.
Continuing education and staff development professionals can assist nurses to
conduct effective literature searches. This article provides suggestions for
strategies to aid in identifying search terms. Strategies also are recommended
for refining searches by using controlled vocabulary, truncation, Boolean
operators, PICOT (Population/Patient Problem, Intervention. Comparison,
Outcome, Time) searching, and search limits. Suggestions for methods of
managing resources also are identified. Using these approaches will assist in
more effective literature searches and may help evidence-based practice
decisions.
