The focus of this article is on the critical role that a staff nurse holds in implementing an evidence-based practice (EBP) model. Implementing a change in practice takes research, analysis of data, and applying the complied results to practice. In this case study, communication was a crucial component that was identified. And it was found that there was an, “increased use of best evidence for patient care, increased opportunities for leadership by staff nurses, improved critical thinking skills, and improved communication skills” (Reavy & Tavernier, 2008, p. 172).
The Nursing School at Boise State University joined in a partnership with one of the local medical centers to implement an EBP model. The medical center distinguished a need to utilize more EBP in patient care so a project was initiated and successfully completed. Throughout the stages of the project, there was an awakening of what nurses can contribute to their own practice. The staff nurses were the central focus of this project. “Staff nurses “drive the machine” of evidence-based practice, because they observe, assess, ask questions, pass on ideas, and implement new knowledge into clinical practice” (Reavy & Tavernier, 2008, p. 167).
At the end of the project there was a renewed sense of empowerment as a nurse. With the introduction of a hands-on implementation of EBP the nurses honed in on several different skills. Critical thinking was sharpened, change was implemented without rebuttal, nurses could speak up and be heard, and their self-confidence was bolstered in their area of expertise.
Steps (by nursing) to develop & implement EBP: An inpatient oncology unit was chosen for the environment in which this case study was completed. A group of four staff nurses, ...
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...eates opportunities for staff nurses to recognize ownership of their practice and their role in changing the practice setting to a culture of evidence-based practice” (Reavy & Tavernier, 2008, p. 166).
Bergman, J., & Bergman, N. (2013). Whose choice? Advocating birthing practices according to baby's biological needs. Journal of Perinatal Education, 22(1), 8-13. doi:10.1891/1058-1243.22.1.8
Moore, E. R., Anderson, G. C., & Bergman, N. (2007). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews (Online), (3), CD003519. doi:10.1002/14651858.CD003519.pub2
Reavy, K., & Tavernier, S. (2008). Nurses reclaiming ownership of their practice: Implementation of an evidence-based practice model and process. Journal of Continuing Education in Nursing, 39(4), 166-172. doi.org/10.3928/00220124-20080401-07
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The Johns Hopkins Nursing Evidence-Based Practice Model provides nurses with a system to formulate a practice question, appraise both research and non-research evidence, and to develop recommendations for practice (Dearholt & Dang, 2012). This model guides nurses through the evidence-based research process with ease and minimal difficulty using a problem solving approach.
EBP is a method of finding evidence and using it in practice: as Blaney (1986) states, it is used to assess health, plan, implement, and evaluate individualized care (p.182). Finotto et al. (2013) breaks EBP down into steps as follows: Formulate a research question; find the most relevant evidence; appraise evidence; integrate evidence with clinical experience and patient values to make practical decisions; and evaluate the outcome (p.460). Carrazzone (2009) and Moch et al. (2010) argue that didactic components with EBP integrated into the education are believed to be beneficial to studen...
The Iowa model, developed by Titler in 1994, focuses on organization and collaboration incorporating conduct and use of research, along with other types of evidence (Titler et al, 2001). Since its origin in 1994, it has been continually referenced in nursing journal articles and extensively used in clinical research programs (LoBiondo-Wood and Haber, 2006). This model allows us to focus on knowledge and problem-focused triggers, leading staff to question current nursing practices and whether care can be improved through the use of current research findings (Titler, 2006). In using the Iowa model, there are seven steps to follow: (1) selection of a topic or problem for evidence-based practice, (2) forming a team, (3) Evidence retrieval, (4) Grading the Evidence, (5) Developing an EBP Standard, (6) Implement the EBP, and (7) Evaluation (Titler et al, 2001.
A nurse is required to be responsible and accountable, updating their knowledge and skills continually by using professional development (NMC, 2008). This requires an understanding and awareness of what Evidence Based Practice (EBP) is. Nurses make decisions about their practice using EBP. Ways in which this can be utilized in the improvement of knowledge and practice is, for example; using established sources of evidence. (Marquis et al, 2012). Nursing practice uses a range of approaches to improve and develop patient care so as a nurse the skill of evaluating sources of evidence is necessary to do this effectively. Evidence is gathered through research. EBP consists of research, data collection and nursing research. When searching for evidence to improve your practice the range of information available is vast. A distinction must be made between evidence that is reliable under scrutiny and evidence which is unreliable. Fitzpatrick (2007) asserts that, to understand evidence based practice is to understand where to look and what credible sources of evidence are. Sources that are credible include information published by a government body or academic institution. Fitzpatrick (2007) recommends identifying key aspects of information of the source to ascertain its credibility, for example; who is the author and where did the research come from? Is the article true or false and how long has it been there? (Fitzpatrick, 2007). A journal article is scrutinised by peers and editors and publishers, whereas in contrast a piece of information on a general website could be published by any person and make any claim and may not pass scrutiny under a peer review. Databases like EBSCO for example have articles that are peer reviewed.
Evidence –Based Practice is a process through which scientific evidence is identified, appraised, and applied in health care interventions. This practice obliges nursing experts to depend on logical research and confirmation more frequently than experience or instinct. EBP is intended to guide medicine of patients in a regulated methodology. This model joins together research, investigation and patient history to give the most exhaustive consideration conceivable. EBP got mainstream throughout the late 1970s. In any case, the thoughts behind the practice were presented much sooner than by nursing pioneer Florence Nightingale. As stated by Carole Cooper, "Nightingale evaluated nature's turf, gathered information, distinguished intercessions and observed patient results." This methodology mirrors current evidence- based practice. Utilization of EBP expanded throughout the 1970s and 1980s in light of calls for additional productivity in patient consideration. While restorative exploration discoveries were accessible, specialists and attendants were not equipped to get to or execute the new data rapidly enough. This new system joined together components of useful information and experience with clinical examination discoveries and investigation.
Evidence-based practice integrates best current evidence with clinical expertise and patient/family preferences and values for the delivery of optimal health care (qsen.org). Like most medical professions, nursing is a constantly changing field. With new studies being done and as we learn more about different diseases it is crucial for the nurse to continue to learn even after becoming an RN. Using evidence-based practice methods are a great way for nurses and other medical professionals learn new information and to stay up to date on new ways to practice that can be used to better assess
Evidence-based practice (EBP) is a process, a clinical master tool, so to speak, used by the nurse who is focused on positive outcomes in patient care. Registered Nurses (RNs), that assume a leadership role, continuously assess their practice in order to find out what is working and what is lacking or in need of more information (Barry, 2014). The RN who uses EBP strives to prevent healthcare errors, critically thinking through processes and anticipating obstacles, methodically drawing upon clinical research and expertise, including their own knowledge and drawing upon the individual patient experience toward improving safety and quality care (Barry, 2014). This systematic approach sets the RN apart from others, who may otherwise be tempted to remain stuck in old ineffective routines, and allows the RN the unique opportunity to affect change, most importantly, change that is directed toward keeping patients safe and receiving the best quality care (Barry, 2014).
Observation of the unit interface exemplified the need to identify, understand, and reject WPB with expectation to promote civility and cohesiveness, which would bring about a change to promote the best patient care. Under the auspice of EBP the nurses must rise to the challenge of delivering optimal patient care for it is imperative to evolve. To accomplish this standard a medium is needed for the process. The Iowa Model to improve quality of care considers all facets of the healthcare system, through established seven steps to change; this is one theoretical model to use for the mandate that all nurses must encompass the philosophy of EBP. One viewpoint is, would purging WPB stimulate civility and cohesiveness in the unit to
When performing evidence based practice research, the Iowa Model uses a team or individual approach to assist nurses in the journey to quality care. The Iowa Model begins by offering a process of selecting a proper clinical topic, which is often a recurring problematic issue (Polit & Beck, 2012). This topic is formulated as a question to improve a technique or procedure. Once the researcher determines that an ample amount of reported investigation exists on the desired question, information may be gathered and presented for approval (Polit & Beck, 2012). The research may lead to a gradual change in nursing practice.
Although, many a times, the biggest barrier to deliver the best treatments are the senior health care professionals and the nursing leaders who do not entertain the implementation of the interventions planned based on the evidences obtained from research studies (Eizenberg, 2011). This is because most of the leaders were educated when either evidence based on research practices did not exist or were not well integrated into the educational programs and are thus strict followers of ritual or opinion based practices (Newton & McKenna, 2009). Thus, when the new generation nursing professionals who have learnt to utilize evidence based on research practices enter the nursing world, they are posed with challenges of whether to follow their seniors or to follow what is ethical according to them (Newton & McKenna, 2009). Even the political and organizational cultures that are resistant to changes form the biggest barrier. Such barriers act as a huge problem that prevents the best outcomes for patients (Melynk,
Polit and Beck (2010 p. 4) describe the research process as “a systematic inquiry designed to develop trustworthy evidence about issues of importance to the nursing profession, including nursing, practice, education, administration and informatics”. With the use of research, nurses can update themselves with the knowledge and analytical skills necessary to facilitate the use of appropriate evidence in clinical decision making for effective health service delivery (Greenhalgn 2010). Clinical decisions should be supported by current, appropriate and robust evidence rather than invalid primary training or the interpretation of personal experiences (Thompson and Dowding 2002). Baker (2010 p. 6) defines EBP as “the conscientious, explicit and judicious use of theory-derived, research-based information to make decisions about care delivery to individuals or groups of patient, taking into consideration individual’s needs and preferences”. It offers the nurse with the skills and knowledge to assess best update health care literature and practice (Donald and Greenhalgh
One feature of evidence based practice is a problem-solving approach that draws on nurses’ experience to identify a problem or potential diagnosis. After a problem is identified, evidence based practice can be used to come up with interventions and possible risks involved with each intervention. Next, nurses will use the knowledge and theory to do clinical research and decide on the appropriate intervention. Lastly, evidence base practice allows the patients to have a voice in their own care. Each patient brings their own preferences and ideas on how their care should be handled and the expectations that they have (Fain, 2017, pg.
Evidence based practice (EBP) is a key component in delivering cost-effective, high quality health care.  However, only around half of the care providers in the United States utilized EBPs. Additionally, nearly a quarter of services delivered to American consumers are unnecessary and potentially harmful. Today, educators are teaching and promoting evidenced based health care to future nursing professionals. The Institute of Medicine (IOM) supports this action as a means to achieve the objective that 90 percent of all medical treatments have a foundation in evidence based practices by the year 2020.