CONTINUING EDUCATION
Translating Evidence Into Practice: How
Advanced Practice RNs Can Guide Nurses in
Challenging Established Practice to Arrive at
Best Practice 2.1 www.aornjournal.org/content/cme
JENNIFER L. FENCL, DNP, RN, CNS, CNOR;
CANDACE MATTHEWS, MSN, RN, CPNP, CNS
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Conflict-of-Interest Disclosures
Jennifer L. Fencl, DNP, RN, CNS, CNOR, and Candace
Matthews, MSN, RN, CPNP, CNS, have no declared affiliations that could be perceived as posing potential conflicts of
interest in the publication of this article.
To provide the learner with knowledge of best practices related
to translating evidence into clinical practice.
The behavioral objectives for this program were created by
Kristi Van Anderson, BSN, RN, CNOR, clinical editor, with
consultation from Susan Bakewell, MS, RN-BC, director,
Perioperative Education. Ms Van Anderson and Ms Bakewell
have no declared affiliations that could be perceived as posing
potential conflicts of interest in the publication of this article.
Objectives
Sponsorship or Commercial Support
1. Discuss the concept of evidence-based practice (EBP) and
the importance of using evidence to guide practice changes.
2. Identify the barriers to implementing EBP.
3. Explain the role of the advanced practice RN (APRN) in
promoting EBP.
4. Discuss using EBP models to guide practice change.
5. Describe how to search and critically appraise the literature
and disseminate information on best practices.
No sponsorship or commercial support was received for this
article.
Purpose/Goal
Disclaimer
AORN recognizes these activities as CE for RNs. This
recognition does not imply that AORN or the American
Nurses Credentialing Center approves or endorses products
mentioned in the activity.
http://dx.doi.org/10.1016/j.aorn.2017.09.002
ª AORN, Inc, 2017
378 j AORN Journal
www.aornjournal.org
Translating Evidence Into Practice: How
Advanced Practice RNs Can Guide Nurses in
Challenging Established Practice to Arrive at
Best Practice 2.1 www.aornjournal.org/content/cme
JENNIFER L. FENCL, DNP, RN, CNS, CNOR;
CANDACE MATTHEWS, MSN, RN, CPNP, CNS
ABSTRACT
Nursing is an information-intensive profession, requiring nurses to have high information literacy and the
skills to find, understand, evaluate, and use information from a multitude of sources. The advanced
practice RN (APRN) is a valuable resource to support and guide nurses in this effort. The APRN’s skills
encompass understanding and implementing evidence-based practice, evaluating the organizational
structure (eg, units, facilities, multisystem organizations) across the continuum of care, and facilitating
collaboration between perioperative nurses and other interprofessional team members to sustain
practice changes in the clinical setting. Perioperative APRNs play an important role as evidence-based
practice experts to assist with translating research and evidence into clinical practice for safe, quality
care in the perioperative setting. AORN J 106 (November 2017) 378-392. ª AORN, Inc, 2017.
http://dx.doi.org/10.1016/j.aorn.2017.09.002
Key words: evidence-based practice, advanced practice registered nurse, translating research,
literature appraisal, EBP models.
M
any perioperative nurses may recall when the
surgical team did not wear gloves to handle
specimens or to count used surgical sponges,
or when perioperative nurses prepped patients with pure 70%
isopropyl alcohol from chin to toes and there was no minimum three-minute drying time. Current practice guidelines
may make these actions seem unusual. Many nurses may have
experienced these shifts in practice, however. Nurses may
wonder what has changed over the years to result in a paradigm shift away from these previously common practices. One
aspect of health care that has evolved is the wide acceptance
and infusion of evidence-based practice (EBP) to guide clinical practice.
WHAT IS EBP?
Relying on tradition or past experience and using the old adage
“because that is the way we have always done it” to rationalize
clinical practice is becoming a practice of the past. Evidencebased practice is globally accepted across health care disciplines as the fundamental framework to formulate and deliver
the best clinical practice for patient care.1,2 Clinical practice
that is firmly grounded in evidence is a critical step toward
improving the quality of care delivered to individualsdit has
the potential to enhance patient outcomes, establish a culture
of safety, and decrease health care costs.1,2
Evidence-based practice, also referred to as evidence-based
medicine, is the practice of delivering exceptional patientcentered care by understanding and transitioning the best
scientific evidence (ie, research) into practice and combining
that knowledge with clinical expertise and patient values and
wishes.1,3-5 The Institute of Medicine compels organizations
to be knowledge driven by establishing the goal that by 2020,
90% of all clinical decisions will originate from the best
http://dx.doi.org/10.1016/j.aorn.2017.09.002
ª AORN, Inc, 2017
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available evidence.1,6 By grounding clinical decisions in
evidence, clinicians ensure the use of accurate, timely, and
up-to-date clinical information.6
Another way to view EBP is to consider the question, “What is
health care quality?” The Institute of Medicine defines health
care quality as the degree to which health services for
individuals and populations increase the likelihood of desired
health outcomes and are consistent with current professional
knowledge.7 Health care providers must have knowledge of
current evidence and the ability to communicate with patients
about the scientific value of interventions and implications of
treatment options to provide quality care.8,9 Added facets
thought to drive health care quality are the availability of
publicly reported hospital quality data and informed
consumers.10,11 Hospital leaders state that public reporting
stimulates engagement in quality improvement initiatives in
health care organizations and plays a major role in influencing
planning and annual goal-setting,11 thus elevating the organization’s focus on care quality. The public has the ability to
easily obtain specific quality information for organizations,
enabling consumers to be selective regarding where they
choose to receive care.10
Barriers to EBP
Although clinicians generally recognize the importance of
knowledge-driven health care organizations and embrace the
notion of EBP, many health care providers, including nurses,
experience barriers related to the implementation of EBP in
their clinical setting.1,12-14 Common barriers to nurses
embracing EBP that can also lead to a lack of confidence in
implementing EBP may include
limited understanding of research and terminologies,
lack of confidence in critically appraising the literature
(eg, analyzing and synthesizing),
inexperience with computer and library searching,
time constraints,
lack of support from colleagues or leaders, and
accepting established practice instead of challenging whether
it is EBP or best practice.1,12-14
Another barrier to implementing EBP in the practice setting
involves the different levels of preparatory nursing education
(eg, licensed practical nurse, associate degree, bachelor of
science in nursing) and the variations in exposure to EBP during
school.15 Therefore, when providing education regarding
implementing EBP, a thorough assessment of baseline staff
member knowledge is imperative to determine existing gaps and
how to progress with educational initiatives.15
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In addition, nurses work in environments where there is a
proliferation of health-related information that is easily accessible and offers a substantial number of options for reviewing
and applying to practice.16 The profession of nursing itself is
information intensive, requiring nurses to be well versed in
information literacy with a skill set that must include the ability
to find, understand, evaluate, and use a variety of information
from a multitude of sources while quickly ascertaining which
ones are reliable.16 Therefore, finding accurate information
from reliable sources is another barrier to embracing EBP.
Nurses need strategies to overcome these barriers to translating
the best evidence found in the literature into practice. One
way to accomplish this is to involve perioperative advanced
practice RNs (APRNs). Recognized as EBP experts, APRNs,
whether masters or doctoral prepared, can offer advanced
clinical expertise while serving as change agents for systemwide
projects.17 Advanced practice RNs also are nursing leaders
who have had formal preparation and experience with EBP
and are well versed in research methods.17
ADVANCED PRACTICE RNS: DRIVING
CLINICAL PRACTICE
Advanced practice RNs have a unique role that involves
identifying and promoting EBP in health care organizations.
Whether in a small facility or a large, multisystem health care
setting, APRNs provide essential oversight and coordination of
specialty services or patient populations across multiple areas
while working to ensure the highest standards and quality of
care.18 Advanced practice roles in the perioperative setting
include the clinical nurse specialist, nurse practitioner, certified
registered nurse anesthetist, and certified nurse midwife.
A key function of an APRN is evaluating the applicability of
practice changes in an organization. Advanced practice RNs
routinely act as change agents in an effort to support bedside
nurses to assume ownership and accountability for their
nursing practice by firmly understanding the rationale for EBP
changes.19 To be effective change agents, APRNs must
understand the organizational macrosystem and the departmental microsystem and be able to appropriately articulate
organizational goals to bedside nurses. The APRN should
anticipate, identify, and remove barriers to encourage the
successful implementation and sustainment of practice
changes. Advanced practice RNs often serve as conduits for
connecting key stakeholders from relevant interprofessional
teams when implementing EBP.20
Decisions regarding changes to practice should involve bedside
nurses. Advanced practice RNs have a strong link to the
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practice environment and can see and appreciate obstacles that
bedside staff members face on a regular basis.20 This understanding of the importance of bedside staff member input and
careful evaluation of current workflows assist APRNs with
restructuring those workflows to best support the implementation and incorporation of EBP.20,21
Use of EBP is essential for care across the health care
continuum. Advanced practice RNs are trained to understand
the paradigm shift in health care (eg, emphasis on population
health, health care reform) and are well suited to provide
patients with robust education regarding disease processes and
management and ensure routine outpatient follow-up for
patients with chronic and complex illnesses.7,18 This can
include collaboration with outpatient providers in the community to enhance compliance with evidence-based care
guidelines across the continuum of care.7 The perioperative
APRN also plays a key role during a patient’s preoperative and
postoperative phases of care. For example, by using evidencebased patient education strategies, the APRN can be pivotal in
partnering with patients preoperatively and postoperatively
and helping them to understand the necessary actions they can
take to actively participate in preventing surgical site infections
or other potential complications.
EBP MODELS
Many models are available to guide APRNs and perioperative
RNs through the EBP implementation process. These established models provide the framework and structure for the
process of integrating the best available evidence while incorporating the provider’s clinical expertise and the patient’s
values in the pursuit of the best clinical decision for care.
Sidebar 1 highlights several EBP models that are available to
help guide nurses during the EBP implementation process.
Any APRN or perioperative RN should explore whether his or
her organization has already chosen a specific EBP model to
use to support a consistent approach to EBP throughout the
organization. Core elements that can be found in each of the
EBP models include
asking the clinical question,
performing a thorough literature review to obtain relevant
information,
critically appraising the literature,
implementing the evidence into clinical practice,
evaluating the outcomes, and
sharing the results through dissemination.1,3,5,22-24
Asking the right clinical question is a pivotal component of
any EBP model. A commonly used format to ask the right
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Translating Evidence Into Practice
clinical question is the PICO format. The PICO acronym
stands for
P ¼ patient population of interest,
I ¼ intervention or issue of interest,
C ¼ comparison of the intervention or group, and
O ¼ outcome.2,23,24
It is also known as PICOS (S ¼ study design) for qualitative
methods or PICOT (T ¼ time frame).2,23,24 Sidebar 2
includes examples of perioperative PICO questions.
HOW TO SEARCH THE LITERATURE
Equally important as developing the right clinical question is
performing a thorough literature review. Keys to successfully
identifying the best evidence include the ability to not only
find information but to find the information from
reliable sources.16
Clinical practice guidelines (eg, AORN’s Guidelines for
Perioperative Practice)25 reflect systematic, robust, and evidencebased recommendations based on comprehensive reviews of the
current evidence on clinical topics and can be immensely
valuable2 to perioperative nurses. Nurses can search the Agency
for Healthcare Research and Quality’s National Guideline
Clearinghouse web site to find clinical practice guidelines
related to certain topics or specialties or from particular organizations.26 Other related and reliable sources of information
include professional guidelines and position statements.2,27
Advanced practice RNs can help nurses choose and search
appropriate databases in pursuit of information from reliable
sources. In general, professional online databases or search
tools that access professional databases, such as PubMed,
Ovid, MEDLINE, the National Center for Biotechnology
Information, and the Cumulative Index to Nursing and Allied
Health Literature (CINAHL); and government (ie, .gov) web
sites such as those of the Centers for Disease Control and
Prevention and the US Department of Health and Human
Services, are appropriate sites because they publish reliable,
peer-reviewed information.16 Health care professionals in the
government maintain .gov sites and provide contact information that readers can use to seek clarification of information.16 Additional online academic search engines to access
scholarly articles include Google Scholar, RefSeek, and JURN.
Searching these professional databases increases the likelihood
that the information is reliable, because experts in the
profession have reviewed the information; however, each
article should be assessed and appraised on its own merit.16 In
general, public search engines (eg, Google, Bing, Yahoo)
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Sidebar 1. Overview of Evidence-Based
Practice Models1
Iowa Model of Evidence-Based Practice to Promote
Quality Care: This model is recognized for its applicability in a variety of settings and for its ease of use.
It promotes quality of care by creating a framework for
providers to address day-to-day clinical issues by using a
scientific process focused on outcomes, starting with
identifying a trigger either from a clinical issue or new
knowledge.
Johns Hopkins Nursing Evidence-Based Practice
Model: This model was developed to support bedside
nurses in translating a variety of evidence into many
practice settings (eg, clinical, administrative, educational). It incorporates three core domains (ie, practice
question, evidence, translation) to approach and integrate evidence-based practice (EBP) into practice.
The Stetler Model of Evidence-Based Practice: This
model was created to provide a process to realistically
apply research findings to clinical practice. It provides
an outline through a series of steps and focuses on
targeted critical thinking at the level of the individual
practitioner.
Model for Evidence-Based Practice Change: Designed
to provide a framework to guide many practice change
initiatives, this model integrates the concepts of quality
improvement, teamwork tools, and EBP translation
approaches to implement new clinical practice.
The Advancing Research and Clinical Practice
Through Close Collaboration Model: Initiated to
offer health care organizations and clinical settings a
tangible framework encompassing systemwide application and sustainability of EBP-focused quality outcomes, this model recognizes the importance of
clinicians adept in EBP and promotes cultivating EBP
at the individual and organizational level.
Promoting Action on Research Implementation in
Health Services Framework: Reflecting on the multiple layers of translating the best evidence into practice,
which is a complex, multifaceted, and dynamic process,
this model provides the conceptual framework to
achieve EBP through behavior changes at the individual,
team, and organization level with three key elements
(ie, evidence, context, facilitation).
The Clinical Scholar Model: Created to foster the
spirit of inquiry, provide education to bedside clinicians,
provide support and mentorship for the process of EBP,
and facilitate research at the point of care, this model
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promotes developing the capacity and skillset for longterm application of EBP into clinical practice.
Reference
1. Dang D, Melnyk BM, Fineout-Overholt E, et al. Models to guide
implementation and sustainability of evidence-based practice.
In: Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in
Nursing & Healthcare: A Guide to Best Practice. 3rd ed.
Philadelphia, PA: Wolters Kluwer Health; 2015:274-315.
should be avoided or used with discretion when seeking
evidence-based information, because the information obtained
from these sites may or may not be reliable.16
MAKING SENSE OF IT ALL: CRITICALLY
APPRAISING THE LITERATURE
One of the foundations of EBP is grounding clinical practice
and decisions in the best and strongest evidence available.28,29
It is essential to critically appraise the literature by analyzing
and synthesizing information to determine what is the best
and strongest evidence available to help provide answers to the
clinical question at hand.28,29
Advanced practice RNs can assist nurses in sifting through the
available evidence to find the best and strongest evidence
because they are well versed in the hierarchy of evidence. The
hierarchy of evidence (Figure 1) provides guidance on
critiquing the evidence for strength, quality, and reliability for
the clinical practice question.29 Critically appraising a study
involves evaluating whether the results of the study are valid
and if the results apply to the population in which the RN or
APRN is interested.29 Important elements to examine during
this process are clinical significance (ie, clinical effect) and
statistical significance (ie, whether the results occurred by
chance).29 If the researchers find a result to be statistically
significant, that does not necessarily mean the result is clinically important or that clinicians should change their practice
based on one research study.
In addition, critically appraising the literature involves evaluating a study for bias, industry funding, generalizability to the
practice setting, strong clinical designs, effect on care, and
limitations.30 By understanding how to select the articles with
the strongest level of evidence available, APRNs and perioperative RNs may identify credible resources to enhance clinical
practice. In addition to using the hierarchy of evidence to
evaluate the study design, nurses may use a variety of tools,
such as the AORN Evidence Rating Model (Figure 2),
AORN’s Research and Non-Research Evidence Appraisal
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November 2017, Vol. 106, No. 5
Sidebar 2. Examples of Perioperative PICO
Questions
The acronym PICO represents patient population of
interest (P), intervention or issue of interest (I), comparison of the invention or group (C), and outcome (O).
Question 1: What is the best skin antiseptic to use to
decrease the incidence of surgical site infections (SSIs)
for open abdominal surgical procedures?
o P ¼ Patients undergoing open abdominal surgical
procedures
o I ¼ Skin antiseptic
o C ¼ Patients who developed an SSI compared with
those who did not develop an SSI
o O ¼ Decreased incidence of SSIs
Question 2: Does skin-to-skin contact between the
mother and neonate in the OR affect the use of IV
antianxiety medication or narcotics after delivery to
treat maternal anxiety?
o P ¼ Mothers who experienced skin-to-skin contact in
the OR
o I ¼ Skin-to-skin contact in the OR
o C ¼ Mothers who did not experience skin-to-skin
contact in the OR (implied)
o O ¼ Effect on postdelivery use of IV antianxiety
medication or narcotics to treat maternal anxiety
Question 3: Is touch therapy an effective intervention to
decrease postoperative nausea and vomiting for patients
who have undergone an open abdominal procedure?
o P ¼ Patients who have undergone an open abdominal
procedure
o I ¼ Touch therapy
o C ¼ Patients who did not have the intervention of
touch therapy (implied)
o O ¼ Decreased postoperative nausea and vomiting
Tools,31 or the Grading of Recommendations, Assessment,
Development, and Evaluation (GRADE) system.32 These
tools may help nurses evaluate the certainty of evidence and
strength of clinical recommendations. They also provide a
structure for clinicians to make judgments about a published
study’s relevance to clinical care.33
PULLING IT ALL TOGETHER: EBP IN
ACTION
After a clinician obtains high-quality evidence from the
literature to support practice changes in a health care
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Translating Evidence Into Practice
organization, there are often personal and organizational
barriers to implementing changes.34 For changes in clinical
care to be effectively implemented, the organization must
have buy-in from staff members and other stakeholders and
reasons to support the change.8 Although the implications of
improved patient care should be the most important aspect
when deciding to adopt a change in care, the decision to
implement the change includes costs associated with the
change and the return on investment.35 With exorbitant
health care costs throughout the United States, the concept of
value-based purchasing has intensified the focus of EBP and
serves as a catalyst for many health care organizations to
investigate practices to ensure that clinicians deliver the
highest quality of care.36 Health care organizations must
remain financially viable while providing exceptional care
with improved outcomes.
The most challenging aspect of translating evidence to practice
is often related to changing behaviors and sustaining those
behaviors rather than simply providing the education for
change.30 Most health care professionals would likely agree
that evidence supports performing hand hygiene before and
after each patient interaction and that this is the most
important method to prevent the spread of infection in the
health care system.37 Proper hand hygiene compliance rates in
many organizations, however, are far below acceptable (on
average, health care providers clean their hands less than half of
the times they should).38,39 Clinicians not only need to be
informed regarding the expectations of hand hygiene, they
need to fully understand the rationale surrounding the
importance of hand hygiene and the numerous sources of
evidence supporting this practice.37 The APRN plays a vital
role in helping staff members see the broader range of the
effect that practice changes may have on providing quality care
and identifying other structural or environmental changes that
need to be implemented (eg, optimal location of hand-washing
or hand hygiene stations).
One example of how APRNs can foster evidence-based change
is by using specific patient stories or narratives to assist in
communicating with staff members about the effect of
adhering to best practices, because this provides an emotional
component that has been shown to affect behavior changes
among staff members.34 Another method APRNs may use to
support and hardwire adoption of EBP is to harness the power
of the electronic medical record, especially regarding the
standardization of perioperative patient care.40-42 For example,
using the electronic medical record to capture data on surgical
site infection bundle compliance, on-time starts, or improvements needed in documentation42 may help health care
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Figure 1. Explanation of the types of evidence that the hierarchy of evidence comprises.
leaders identify trends, progress, or opportunities related to
improving patient care. In addition, standardized order sets
and pop-up tools (eg, best practice alerts) may help remind the
user to take the steps necessary to follow EBP and deliver safe
patient care.
Health system changes can be slow to implement because
clinical practice change often involves multiple disciplines.30
Before implementing any clinical practice change, participants
should explore the perspectives of all stakeholders and examine
the effect that a change will have on each discipline.30
Sidebar 3 showcases an example of implementing a perioperative project using an EBP model.
REMEMBERING THE IMPORTANT FINAL
STEP: DISSEMINATION
Disseminating evidence-based findings is perhaps one of the
most difficult, yet arguably one of the most important, steps of
implementing evidence into practice. The general objectives in
disseminating evidence-based findings include increasing the
availability of relevant information and encouraging others to
implement research findings into clinical practice.34,43
Disseminating evidence is important both internally and
externally. Examples of sharing evidence internally include
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presentations at staff meetings or preparing an article for the
departmental newsletter.43 External dissemination may occur
on local, state, national, or international platforms and may
include poster and oral presentations, both formal (eg, podium
presentation at the AORN Global Surgical Conference &
Expo, feature on the local television news) and informal (eg,
speaking to high school students or a group of community
volunteers), and in publications (eg, a press release to the local
media, journal article).43
Organizational support (eg, providing financial support for
presentations at conferences) for nurses who aim to implement
evidence in practice is crucial to the success of disseminating
EBP.36 Health care leaders who support the dissemination of
evidence-based findings benefit the organization and benefit
the profession by adding to the body of nursing knowledge.
Nurses who feel supported and valued are more likely to
continue to identify gaps in practice and implement changes to
positively affect patient care.44 Nurses who feel professionally
fulfilled, involved, valued, and autonomous in decision making are more likely to remain with a health care organization,44
and high turnover rates can negatively affect patient outcomes.45-47 By reducing turnover, organizations can achieve
improved patient satisfaction rates, patient care outcomes, and
nurse satisfaction rates.47 Patients are choosing to evaluate
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Translating Evidence Into Practice
Figure 2. The AORN Evidence Rating Model. Reprinted with permission from AORN.org. Copyright ª 2015,
AORN, Inc, 2170 S Parker Rd, Suite 400, Denver, CO 80231. All rights reserved.
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Sidebar 3. Example of an Evidence-Based
Practice Project Using the Iowa Model as
the Framework
Below is an example of how personnel at Cone Health,
Greensboro, North Carolina, used the Iowa Model1 to
answer this clinical question: “Do OR RNs correctly
document wound classification (WC)?”
Step 1: Identify the trigger and determine whether it is
problem focused or knowledge focused.
o Wound classification is an element that many OR
RNs document for every surgical procedure. Leaders
at our health care organization had several questions
to address, including: Do OR RNs have a full understanding of the importance of documenting accurate WC, and is the patient’s intraoperative electronic
record accurately capturing the WC data? We
considered this evidence-based practice (EBP) project
to be a problem-focused trigger because the WC data
element was not being captured accurately in the
patient’s electronic record by the perioperative RN,
thus skewing benchmark data used to evaluate best
practices regarding surgical site infections.
Step 2: Identify the purpose and determine whether
the problem is a priority for the organization.
o It is important to have accurate data regarding safety
and quality initiatives. Equally important is an intraoperative record that accurately reflects nursing
documentation. Our health care organization was
using these data as benchmarks to evaluate best
practices regarding surgical site infections, and the
organization strives to achieve accurate documentation, so organizational leaders deemed this trigger to
be a priority.
Step 3: Form a team and assemble, appraise, and synthesize the literature to determine whether there are
sufficient published studies to merit making practice
changes.
o An interprofessional team was formed; it included a
perioperative clinical nurse specialist (CNS), a quality
facilitator, a surgeon champion, OR RNs, surgical
technologists, surgeons, and department and executive
leaders (ad hoc for support). The team evaluated the
best evidence on surgical WC and performed documentation audits to understand and define the current
state (ie, collect baseline data). The team identified
several opportunities for improvement, and the focused
process change (ie, EBP quality improvement [QI]
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project) was for the surgeon and the OR RN to verbally
verify WC with each other at the end of the surgical
procedure for accuracy. To aid implementation, this
process change included developing a variety of
tools and resources to aid accurate WC identification and documentation; educating providers and
nursing staff regarding WC and its importance as a
data element; and measuring and reporting regulatory outcomes to verify practice changes are
sustained.
Step 4: Pilot the change into practice, evaluate outcomes,
and modify as needed.
o The team established the goal of a 5% or less
discrepancy rate between the intraoperative record
and the dictated operative note regarding WC (the
baseline data discrepancy rate average was 18% and
ranged as high as 36%). The CNS and quality facilitator randomly audited 10% of all surgical procedures
for each service line and facility for accuracy (intraoperative record compared with dictated operative
note), and they reported results to the team and to
OR leaders and staff members via shared governance
meetings. Based on feedback from the stakeholders,
the team made changes to the process as needed and
created an algorithm for accurate WC documentation.
Step 5: Determine whether the change is appropriate
to adapt into practice and continue to monitor change
with outcome data.
o After a year of piloting this new process, the team
determined that the EBP QI change was important to
continue and monitor. We successfully met the goal
of a 5% or less discrepancy rate between the intraoperative record and the dictated operative note
regarding WC, with some facilities achieving a 0%
discrepancy rate for several months. In an effort to
sustain this new EBP QI change, the CNS and quality
facilitator continued to randomly audit 5% of all
surgical cases for each service line and facility for
accuracy and reported results to the team and to OR
leaders and staff members via shared governance
meetings. The CNS and quality facilitator performed
these audits for four years, with a 5% or less
discrepancy rate between the intraoperative record
and the dictated operative note regarding WC.
Step 6: Disseminate the results so others may learn from
the health care organization’s experience.
o The perioperative CNS and quality facilitator had the
opportunity to disseminate the information on this
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Translating Evidence Into Practice
EBP QI project both internally and externally to a
wide audience via
hospital-based podium presentations to a variety of
audiences;
hospital-based publications;
state and regional poster and podium presentations
across the United States;
several national presentations, including at perioperative
and nonperioperative conferences; and
several publications, including perioperative and
nonperioperative journals.
Reference
1. Buckwalter KC, Cullen L, Hanrahan K, et al; Iowa Model
Collaborative. Iowa Model of Evidence-Based Practice: revisions
and validation. Worldviews Evid Based Nurs. 2017;14(3):175-182.
hospital ratings and selecting where they would like to receive
care. Disseminating descriptions of EBP showcases improvements to patient outcomes to the community and may increase consumer interest in a particular facility.10,11
Advanced practice RNs are not only poised to disseminate
EBP information themselves, but they may also help perioperative nurses overcome barriers to successful dissemination of
EBP. Advanced practice RNs can help perioperative nurses by
mentoring those interested in the dissemination of information, acting as powerful role models with previous experience,
supporting the development of the material, helping to identify audience needs, assisting in organizing and preparing the
presentation of information, and providing constructive feedback to strengthen the presentation of information.43
Advanced practice RNs are nursing leaders who can help
nurses challenge established practice to arrive at best practice.
CONCLUSION
To deliver exceptional patient care, nurses must possess the skill
set to filter through the plethora of information from credible
resources and be able to synthesize and use that information for
safe patient care. Perioperative APRNs play a valuable role in
translating research into clinical practice. An organizational
culture that supports inquiry improves attitudes related to EBP
and provides opportunities for nurses to initiate the EBP process.1 Advanced practice RNs can help organizations create a
culture that supports nurses of all levels to ask clinical questions
and inquire about alternative methods that may achieve better
outcomes to improve the quality of patient care.
Editor’s notes: PubMed and MEDLINE are registered trademarks of the National Library of Medicine, Bethesda, MD. Ovid
www.aornjournal.org
is a registered trademark of Ovid Technologies, Inc, New York,
NY. CINAHL is a registered trademark of EBSCO Industries,
Inc, Birmingham, AL. Google is a registered trademark of Google,
Inc, Mountain View, CA. Bing is a registered trademark of
Microsoft Corporation, Redmond, WA. Yahoo is a registered
trademark of Yahoo Holdings, Inc, Sunnyvale, CA.
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.e1717.
Jennifer L. Fencl, DNP, RN, CNS, CNOR, is the
director of Nursing Practice and Education at Cone
Health, Greensboro, NC. Dr Fencl has no declared affiliation that could be perceived as posing a potential
conflict of interest in the publication of this article.
Candace Matthews, MSN, RN, CPNP, CNS, is a
clinical nurse specialist in Pediatrics at Cone Health,
Greensboro, NC. Ms Matthews has no declared
affiliation that could be perceived as posing a potential
conflict of interest in the publication of this article.
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AORN Journal j 389
EXAMINATION
Continuing Education: Translating Evidence Into
Practice: How Advanced Practice RNs Can Guide
Nurses in Challenging Established Practice to Arrive at
Best Practice 2.1 www.aornjournal.org/content/cme
PURPOSE/GOAL
To provide the learner with knowledge of best practices related to translating evidence into
clinical practice.
OBJECTIVES
1.
2.
3.
4.
5.
Discuss the concept of evidence-based practice (EBP) and the importance of using evidence to guide practice
changes.
Identify the barriers to implementing EBP.
Explain the role of the advanced practice RN (APRN) in promoting EBP.
Discuss using EBP models to guide practice change.
Describe how to search and critically appraise the literature and disseminate information on best practices.
The Examination and Learner Evaluation are printed here for your convenience. To receive
continuing education credit, you must complete the online Examination and Learner Evaluation
at http://www.aornjournal.org/content/cme.
QUESTIONS
1. Evidence-based practice is defined as delivering exceptional patient-centered care by understanding and transitioning the best scientific evidence (ie, research) into
practice and combining that knowledge with clinical
expertise and patient values and wishes.
a. true
b. false
2. One goal of the Institute of Medicine is that by 2020,
_____% of all clinical decisions in health care organizations will originate from the best available evidence.
a. 95
b. 90
c. 100
d. 85
3. Barriers to nurses embracing EBP may include
1. time constraints.
2. lack of confidence in critically appraising the
literature.
3. lack of support from colleagues or leaders.
4. inexperience with computer and library searching.
5. limited understanding of research and terminologies.
390 j AORN Journal
6. variation in exposure to EBP during school.
a. 1, 3, and 5
b. 2, 4, and 6
c. 2, 3, 5, and 6
d. 1, 2, 3, 4, 5, and 6
4. Key functions of APRNs are to
1. articulate organizational goals to bedside nurses.
2. evaluate the applicability of practice changes in an
organization.
3. make financial decisions for the organization.
4. remove barriers to implementing practice changes.
5. serve as a conduit for connecting key stakeholders to
be involved in EBP changes.
a. 4 and 5
b. 1, 2, and 3
c. 1, 2, 4, and 5
d. 1, 2, 3, 4, and 5
5. The EBP model that focuses on the three core domains of
practice question, evidence, and translation is called the
a. Johns Hopkins Nursing EBP Model.
b. Model for EBP Change.
c. Clinical Scholar Model.
d. Stetler Model of EBP.
www.aornjournal.org
November 2017, Vol. 106, No. 5
6. Core elements of EBP models include
1. evaluating the outcomes.
2. critically appraising the literature.
3. asking the clinical question.
4. sharing results through dissemination.
5. performing a thorough literature review.
6. implementing the evidence into clinical practice.
a. 1, 3, and 5
b. 2, 4, and 6
c. 2, 3, 5, and 6
d. 1, 2, 3, 4, 5, and 6
7. When performing a literature search, information found
on public search engines (eg, Google, Bing, Yahoo) is
always reliable.
a. true
b. false
8. The type of study that lacks one or more elements of a
true experiment (eg, lack of randomization) is called a(n)
a. randomized control trial.
b. expert opinion.
c. quasi-experimental study.
d. systematic review.
www.aornjournal.org
Translating Evidence Into Practice
9. Critically appraising the literature involves evaluating a
study for
1. strong clinical designs.
2. clinical roles of the authors.
3. bias.
4. limitations.
5. generalizability to the practice setting.
a. 4 and 5
b. 1, 2, and 3
c. 1, 3, 4, and 5
d. 1, 2, 3, 4, and 5
10. Objectives of disseminating evidence-based findings
include
1. encouraging others to implement research findings
into clinical practice.
2. increasing a nurse’s ability to critically appraise the
literature.
3. increasing the availability of relevant information.
a. 1 and 2
b. 1 and 3
c. 2 and 3
d. 1, 2, and 3
AORN Journal j 391
LEARNER EVALUATION
Continuing Education: Translating Evidence Into
Practice: How Advanced Practice RNs Can Guide
Nurses in Challenging Established Practice to Arrive at
Best Practice 2.1 www.aornjournal.org/content/cme
T
his evaluation is used to determine the extent to
which this continuing education program met
your learning needs. The evaluation is printed
here for your convenience. To receive continuing education
credit, you must complete the online Examination and
Learner Evaluation at http://www.aornjournal.org/content/cme.
Rate the items as described below.
8.
Will you be able to use the information from this article
in your work setting?
1.
Yes
2.
No
9.
Will you change your practice as a result of reading this
article? (If yes, answer question #9A. If no, answer
question #9B.)
9A.
How will you change your practice? (Select all that
apply.)
1. I will provide education to my team regarding why
change is needed.
2. I will work with management to change/implement
a policy and procedure.
3. I will plan an informational meeting with physicians
to seek their input and acceptance of the need for
change.
4. I will implement change and evaluate the effect of
the change at regular intervals until the change is
incorporated as best practice.
5. Other: __________________________________
9B.
If you will not change your practice as a result
of reading this article, why? (Select all that
apply.)
1. The content of the article is not relevant to my
practice.
2. I do not have enough time to teach others about the
purpose of the needed change.
3. I do not have management support to make a
change.
4. Other: __________________________________
OBJECTIVES
To what extent were the following objectives of this
continuing education program achieved?
1.
Discuss the concept of evidence-based practice (EBP)
and the importance of using evidence to guide practice
changes.
Low
1.
2.
3.
4.
5.
High
2.
Identify the barriers to implementing EBP.
Low
1.
2.
3.
4.
5.
High
3.
Explain the role of the advanced practice RN (APRN) in
promoting EBP.
Low
1.
2.
3.
4.
5.
High
4.
Discuss using EBP models to guide practice change.
Low
1.
2.
3.
4.
5.
High
5.
Describe how to search and critically appraise the literature and disseminate information on best practices.
Low
1.
2.
3.
4.
5.
High
CONTENT
6.
To what extent did this article increase your knowledge
of the subject matter?
Low
1.
2.
3.
4.
5.
High
7.
To what extent were your individual objectives met?
Low
1.
2.
3.
4.
5.
High
392 j AORN Journal
www.aornjournal.org