Creating internal expertise
This excerpt was taken from the book, Evidence-Based Practice in Nursing: A Guide to
Successful Implementation
When administrative support is in place and nurses are becoming excited about
undertaking projects and changing practice, start developing expertise about evidencebased practice. Initially, nurses could learn to navigate electronic databases and could
investigate journals that are available in either print or electronic copy in their
organization. If no journals or databases are available, the same outcome can be obtained
by visiting a local hospital that is doing EBP and seeing what journals and electronic
databases they have in place. If the organization has partnered with a local college of
nursing, have nursing staff members schedule an appointment with the reference librarian
to learn how to access the available resources. If there is no dedicated medical or nursing
library readily available, the local community library may have resources, such as
PubMed, that can help you begin to build evidence-based practice resources.
The EBP/nursing research council can organize a list of available journals and databases
and start coordinating educational sessions. One approach that works with nurses who are
novices with research is to focus the initial EBP/nursing research council meetings on
education. Emphasizing education rather than on identifying research questions, selecting
an EBP model, reviewing protocol, or designing studies allows staff nurses the time to
develop their skills. This strategy helps ease interested staff nurses into a contributory
role as they participate in the work of the group and build their skill levels. Initial topics
for the educational sessions could include the following:
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How do I undertake a literature search?
What is evidence-based practice?
Is evidence-based practice for me?
Why is evidence-based practice important to my patients and to our
organization?
Why do we have to do patient care, charting, passing medications, and now
evidence-based practice? Who has time?
How do I get started?
What resources do I need?
What resources are available?
One of the biggest challenges nurses face is learning how to search the literature. Having
a librarian or educator come to the meeting with a laptop computer and do a “real time”
search will build nurses’ confidence in the process of searching electronic resources. As
the group continues to develop knowledge and awareness, more advanced topics can be
added, such as:
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Levels of evidence
Critique of qualitative research articles
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Critique of quantitative research articles
Critique of research proposals
Protection of human subjects
Ethical issues in nursing research
Reliability and validity
Overview of models of EBP
Formulating an EBP or research question
Synthesizing the literature
Developing a clinical practice guideline
Three major barriers often prevent research from being translated into practice: difficulty
finding research articles, uncertainty about evaluating research, and difficulty with
interpreting findings. Participation in journal clubs enhances nurses’ confidence in all of
these areas and prepares nurses for critiquing research, which is an essential component
of evidence-based practice. When conducting journal clubs, a group of nurses meets
regularly to discuss and critique articles from nursing research journals. Articles are
evaluated for scientific integrity and relevance to nursing practice.
The journal club format allows members of the nursing staff to become active
participants in EBP. It serves as a way to bridge research and practice and thereby fosters
the application of research findings into the practice setting. The traditional approach to a
journal club is for nurses to meet as a group for about an hour to critique an article.
However, practice realities can make this difficult to accomplish on a routine basis in
some clinical settings, so after the group is comfortable reading, discussing, and
evaluating articles, consider alternative approaches, such as an electronic online journal
club.
Another strategy that helps nurses develop expertise in evidence-based practice is to have
them develop policies and procedures. Encouraging nurses to develop or update policies
and procedures using the latest research findings helps introduce them to the research
literature. Working together in small groups, nurses can encourage and support each other
in interpreting the findings from various research studies and developing evidence-based
practice.
Once nurses have become comfortable reading and discussing articles, they are ready to
start doing formal critiques of the nursing literature. Guidelines for critique of research
articles can also be found in the Evidence Based Resource Center on
www.StrategiesforNurseManagers.com. Additional guidelines are available in nursing
research textbooks or can be developed for your organizational needs by an advance
practice nurse or research consultant. For example, before using nursing research articles
for policies and procedures or to validate or change practice, one must ask the following
questions:
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Where was the study conducted? What was the setting (e.g., academic medical
center, community hospital, rural hospital, or long-term care facility)?
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Who was in the study population? Were study participants similar to patients
cared for in this organization?
How does the study contribute to the body of nursing knowledge? Do the
study findings make sense?
What are the implications for nursing practice/education/research?
What additional questions does the study raise?
Does the empirical evidence presented in this article support a change in
practice?
What resources would be required to implement the change?
Would the benefits of this practice change or outweigh the risks to patients?
What will be the outcome of this practice change on nurses, patients, or the
organization?
How will the practice change be evaluated?
Another way to develop nurses’ skills is to encourage nurses to be active participants in
any evidence-based practice efforts being conducted by multidisciplinary teams. For
example, the surgeons in a particular hospital might conduct an improvement effort
related to preventing surgical site infections. Including nurses in this effort provides them
with an opportunity to learn while they contribute to the effort. Examining problems from
the multidisciplinary perspective also benefits patients and their families by ensuring best
practices.
Getting started in research and evidence-based practice begins by identifying problems
and prioritizing projects. Identifying situations that result in negative or unexpected
clinical outcomes or by examining hunches made from clinical observations is another
important way to develop research questions. Perhaps one of the most important ways to
become successful in research is to ask questions that are of interest and importance.
More important than knowledge about research, then, is asking questions that have true
clinical meaning and pursuing them with great passion (Beyea, 2000).
Editor’s note: This excerpt was adapted from the book, Evidence-Based Practice in
Nursing: A Guide to Successful Implementation. To find out more about the book and to
order a copy visit http://www.hcmarketplace.com/prod-3737.html.