Running head: EVIDENCE BASED PRACTICE PROJECT
Evidence Based Practice Project
Johan Diaz
University of South Florida
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EVIDENCE BASED PRACTICE PROJECT
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Evidence Based Practice Project
According to the Centers for Disease Control and Prevention (CDC), tobacco use
continues to be the most preventable cause of death and disease in the United States of America
(1999). According to the World Health Organization (2011), tobacco use is responsible for more
than five million deaths every year worldwide. If it continues this way, it is predicted that
tobacco use will take the lives of more than eight million every year by 2030. As research shows,
smoking rates are at an all-time high especially among the adolescent population. The adolescent
population is particularly important because the earlier the onset of smoking, the harder it is to
quit. Smoking cessation is imperative for a better quality of life. Motivational interviewing is a
technique used to enhance a patient’s motivation to change harmful behaviors and follow
through with those changes (Lai, Cahill, Qin & Tang, 2010). Evidence has shown that
motivational interviewing is effective in improving lifestyle changes in patients who have
problems with the following: alcohol abuse, drug abuse, weight management, diet and exercise
(Lai et al., 2010). The clinical guideline retrieved from the U.S. Department of Health and
Human Services website stated that clinicians should use motivational interviewing as an
intervention if the tobacco user is not willing to make an attempt to quit (Fiore et al., 2008).
PICOT question
In adolescents or young adults who are smokers, does a nurse driven intervention of
motivational interviewing versus the use of brief advice improve smoking cessation rates within
six months of hospital discharge?
Infrastructure to Support Practice Change
BayCare’s efforts are aimed at meeting the needs of the customer and improving
customer satisfaction with the services that they deliver (http://www.baycare.org). The
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foundation of BayCare’s philosophy is built upon a Quality Model which includes the following
principles: “Customer Needs,” “Process Focus” and “Continuous Improvement”
(http://www.baycare.org). BayCare encourages the teaching and highlights of their most
successful performance improvements and best practices with other team members in the
healthcare system (http://www.baycare.org). Thus, allowing the implementation of best practices
and communicating the positive changes developed by their teams on a daily basis. The clinical
nurse supervisor will be responsible for approving the project. The charge nurse will track the
use of motivational interviewing by preforming audits on patients charts. The staff nurses can
implement the use of motivational interviewing for the adolescent patients who smoke and have
a lack of motivation to quit. They will also need to document that they are using motivational
interviewing and indicate which stage (pre-contemplation, contemplation, preparation, action,
maintenance) each patient is in. Nurses will be responsible of making follow-up calls at six
months post-discharge.
Summary of Synthesized Literature Review of Best Practice
Literature Search
Academic Search Premier, ScienceDirect and PubMed were the search engines used to
search for the relevant literature needed to answer the identified PICOT question. The search
terms used during the research process are as follows: smoking cessation, brief advice,
motivational interviewing, nursing interventions, adolescent smokers and clinical guidelines.
Synthesis
The research studies have shown that motivational interviewing is effective in smoking
cessation (Colby, 2012; Harris, 2010; Soria, 2006). Among the studies researched, Colby and
Colleagues (2012) was the only study which used adolescents in a hospital setting. When
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compared to a brief advice or anti-smoking advice strategy, motivational interviewing was
superior in affecting cessation rates [F (1,145) =25.09, p<0.001]. However, more research needs
to be completed to determine whether motivational interviewing is the most effective way to quit
smoking. A gap in research has been identified as the patient’s willingness to quit smoking.
Some of the studies included participants regardless of the participant’s motivation to quit. Also
in the majority of the studies researched, motivational interviewing was not delivered by nurses
in the healthcare setting. The clinical guideline used has shown that motivation interviewing
should be used when there is a lack of motivation to quit smoking (Fiore et al., 2008).
Proposed Practice Change
As the clinical guideline retrieved by the U.S. Department of Health and Human Services
stated, clinicians should use motivational interviewing as an intervention if the tobacco user is
not willing to make an attempt to quit (Fiore et al., 2008). The adolescent population will be
targeted because the earlier the onset of smoking, the harder it is to quit. It will be recommended
that the identified patient should receive at least two motivational interviewing sessions before
they are discharged from the hospital and at least one follow-up after discharge. In order to
implement the evidence-based practice guideline effectively, the clinical staff needs to be
educated and trained on motivational interviewing techniques. The clinical data recorded will be
assessed and evaluated for determining future best practice.
Change Strategy
Promote Engagement
Key stakeholders will be encouraged to be involved in the process (Melnyk & FineoutOverholt, 2011). All attitudes and questions concerning the practice in question will be assessed
and addressed to eliminate barriers. Open discussions will be held to address any issues that may
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EVIDENCE BASED PRACTICE PROJECT
come about (Melnyk & Fineout-Overholt, 2011). If a stakeholder voices a concern regarding
motivational interviewing in smoking cessation, the evidence obtained from the literature will be
provided for them.
The Model for Evidence-Based Practice Change
Motivational interviewing in smoking cessation must be identified as a valid evidencebased practice solution. A clinical guideline will then be established to promote the
implementation and compliance of the practice. BayCare uses The Model of Evidence-Based
Practice Change (Melnyk & Fineout-Overholt, 2011) for the implementation Evidence-Based
Practice in the clinical setting. The steps of the model for evidence-based practice change are
introduced in the roll out plan below.
Roll Out Plan
Steps
Step 1
Step 2
Step 3
Definition
Timeframe for Rollout
Assess the need for change in Complete August, 2013
practice
- Include Stakeholders
- Collect internal data for
the identified change in
practice
- Compare data (internal
and external)
- Identify problem
- Make a connection
between problem,
interventions, and
outcomes
Find the best evidence
Completed September, 2013
- Identify different types
and sources
- Review the research
- Plan the search
- Conduct the search
Critically analyze the evidence Completed September, 2013
- Assess and evaluate the
EVIDENCE BASED PRACTICE PROJECT
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evidence
- Synthesize the best
evidence
- Assess probability,
benefits, and risks of the
new practice
Step 4
Design a practice change
November, 2013
- Outline proposed
change
- Identify the resources
needed
- Design the evaluation of
the pilot
- Design the
implementation of the
plan
Step 5
Implement and evaluate
Implement: December, 2013
change in practice
- Implement pilot study
Evaluate: March, 2014
- Evaluate processes,
outcomes, and costs
- Develop conclusions
and recommendations
Step 6
Integrate and maintain change June, 2014
in practice
- Communicate
recommended change to
stakeholders
- Integrate into standards
of practice
- Monitor process and
outcomes periodically
- Celebrate and
disseminate result of
project
Model of evidence-based practice change (Melnyk & Fineout-Overholt, 2011, p. 255).
Project Evaluation
Starting in December 2013, BayCare’s clinical staff will follow a guideline that
implements the initiation of motivational interviewing for adolescents who are not willing to
make an attempt to quit smoking. Data will be collected on all of the adolescents unwilling to
make the change and are subjected to motivational interviewing. An assessment will be made by
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comparing the incidence of smoking cessation for those who received motivational interviewing
and those who received brief advice. The data will be reviewed on a monthly basis to determine
to effectiveness of motivational interviewing in smoking cessation. In order to assess the number
of smokers/non-smokers at 6 months, the clinicians would call the patients to collect the data. A
50% decrease in rates of smoking would need to be achieved in order to determine that the
change in practice was a success.
Dissemination of EBP
A variety of methods can be utilized to disseminate the change in practice. Participation
in meetings to discuss the new clinical guideline and to address any questions is strongly
encouraged. Also providing the stakeholders with the written guideline to be utilized as a
reference, and by sending emails to remind the stakeholders of the change in practice will
improve compliance amongst clinical sites affiliated with BayCare. Posters explaining the new
guideline with the supporting research can be used as method of disseminating this practice into
other hospitals/ institutes. Outcomes of the change in practice can be shared with others at
research conferences and meetings (locally and regionally). If the change in practice is a success,
it can be shared with others by being published in nursing journals. Publishing a paper in a
nursing journal describing the Evidence-Based Practice made could help convey the results to
others inquiring about the same topic. The implementation of motivational interviewing for
adolescents who are unwilling to make a change will expectantly increase the smoking cessation
rates.
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References
BayCare (n.d.) BayCare Website: Culture of Quality. Retrieved from http://www.baycare.org on
November 12, 2013.
Centers for Disease Control and Prevention. (1999). Annual smoking-attributable
mortality, years of potential life lost, and economic costs—United States.
Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5114a2.htm
Colby, S., Nargiso, J., Tevyaw, T., Barnett, N., Metrik, J., Lewander, W., & ... Monti, P. (2012).
Enhanced motivational interviewing versus brief advice for adolescent smoking
cessation: Results from a randomized clinical trial. Addictive Behaviors, 37(7), 817-823.
Fiore, Michael et al. (2008). Treating tobacco use and dependence: 2008 update. U.S.
Department of Health and Human Services. Respiratory Care, 53(9): 1217–1222.
Harris, K., Catley, D., Good, G. E., Cronk, N. J., Harrar, S., & Williams, K. B. (2010).
Motivational interviewing for smoking cessation in college students: A group randomized
controlled trial. Preventive Medicine, 51(5), 387-393. doi:10.1016/j.ypmed.2010.08.018
Lai, D.T.C., Cahill, K., Qin, Y., & Tang, J.L. (2010). Motivational interviewing for smoking
cessation. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006936.
DOI 10.1002/14651858.CD006936.pub2.
Melnyk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and
healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: Wolters Kluwer
Lippincott Williams & Wilkins.
Soria, R., Legido, A., Escolano, C., & Yester, A. (2006). A randomized controlled trial of
motivational interviewing for smoking cessation. British Journal of General Practice,
56(531): 768–774.
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U.S. Department of Health and Human Services. (2012). Preventing Tobacco Use Among Youth
and Young Adults: A Report of the Surgeon General. Atlanta: U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention.
World Health Organization. (2011). WHO Report on the Global Tobacco Epidemic.
Geneva: World Health Organization.