Background
Nurse Practice Structure: Clinical Practice,
Informatics, and Research Council (CPIR)
ensures the integration of evidence-based clinical
practice, informatics and research across the
organization
A sub-group from CPIR focused on implementing
a model of EBP for nursing
Group examined models of EBP and selected
one for use at Children’s
Goals for
Evidenced Based Nursing
Allows the practitioner to assess current and
past practices
Answers the questions “What is the best way
to do this?”
Higher levels of healthcare provider
satisfaction when using EBP
Professional urgency for faster ways to
translate findings into practice
EBP Process
Asking the clinical question in a format that
will yield the most relevant evidence
Finding the relevant evidence
Appraising the evidence
Integrating the evidence into practice
Evaluating the practice change
Evidence Based Practice Models
EBP work group considered multiple EBP
models for Nurse Practice Structure
ARCC Model from the University of
Rochester School of Nursing
Kitson’s Model of EBP
Johns Hopkins Nursing Model of EBP
ACE Star Model
Ottawa Model of EBP
Iowa Model of EBP*
1998 Iowa Model of Evidence-Based
Practice to Promote Quality Care
Selected as the Model to
be implemented at
Children’s by CPIR
Evidenced Based
Practice Work Group
Permission to permission
to adapt and use the
model at Children’s
provided by University of
Iowa Hospitals and
Barriers to EBP at the Bedside
Intimidation that many nurses express
because of their limited knowledge of the
research process, how to find and rate
evidence
Longevity of staff - many nurses did not have
content on EBP as part of their nursing
education
Lack of knowledge on how to implement a
change based on evidence
EBP at the Bedside
Work group brainstormed on how to implement the EBP with the bedside nurse
Interviewed nursing leaders at pediatric health care institutions
Recommendation to develop an EBP nursing scholars fellowship program
– Marilyn Hockenberry, PhD, RN, FAAN – Texas Children’s Hospital
– Pam Hinds, PhD, RN, FAAN, - St. Jude Children’s Research Hospital
Very successful models, attended by staff nurses, supported by nursing leaders in institution
EBP Scholars Fellowship
Program Faculty
Casey Hooke, RN, PhD, CPON, PCNS-BC:
advanced practice nurse and nurse researcher in the Hematology/Oncology
Mari Akre, RN, PhD, NEA-BC : Director for Practice, Informatics and Research
Beverly Clark, RN, BSN, CNOR: Clinical Educator for surgery on the Minneapolis campus
Mary Langevin RN, MSN, CFNP, CPON, HN-BC: advanced practice nurse &
family nurse practitioner in Hematology/Oncology
Planning for Pilot Program
Planning was done over a 12 month period
– Monthly meetings and frequent email communication
Developed a proposal and applied for a grant from Children’s Education and Research Committee
– Grant to support time to for 12 scholars being off the unit, textbooks, librarian time – funding approved 8/08
Bev Clark from our EBP team developed a EBP interactive powerpoint presentation
– Presentation focused on issues relevant to the bedside nurse
– EBP Quiz Bowl part of presentation
Presentation given at unit council meetings to present EBP model and describe upcoming fellowship
Example from EBP Quiz Bowl
Recumbent Position
A standard of practice after Lumbar
Puncture is for patients to remain in
the recumbent position for 30 minutes
to avoid the risk of headache.
Is this a…..
Answer
Sacred Cow. A metanalysis of 16 studies with
a combined total of 1128 patients shows that
"There was no evidence that longer bed rest
after cervical or lumbar puncture was better
than immediate mobilization or short bed rest
in reducing the incidence of headache."
Implication for Practice
Just in oncology alone - we do an average of
10 LP's a week between both campuses.
– 10 X 52 weeks = 520 LP's times 30 minutes is 15,600 minutes or
– 260 hours that patients don't need to be lying around
– Some are getting IV chemo infusions at that time but many could be discharged from clinic or SSU as soon as awake from sedation.
Planning for Pilot Program
Faculty developed curriculum – six 8 hour days
– Set objectives and outlines for each week with CE credits
– Goal was for active learning experiences with discussions
– Curriculum based on successful program at Texas Children’s
Scheduled fellowship Spring/Summer after
winter surge, POE, …
Mentors (APRN’s) incorporated into learning
activities – 1 mentor for every 2 scholars
EBP Scholar Application
Process
Applicants completed an application form which include:
– Their professional experiences
– Their EBP Area of Interest Related to Clinical Practice
– An essay about their reasons for applying to the Scholars program
Also submitted letter of recommendation from colleague or manager
Most applicants are active members of unit councils or have served previously on unit council
Applications were reviewed by the faculty and 12 scholars were chosen
Curriculum Schedule
6 eight hour days
Met weekly (Tuesdays) beginning in
June through July with 2 week break
around 4
thof July
Mentors present every day
Group computer room available with
online access for searches
Curriculum – Week 1
“What is EBP?”
How can it influence practice at the bedside?
Iowa Model – in the clinical setting
Asking the right questions
– The PICO model
Scholars completed the day with a draft of their PICO question
– P Patient population
– I Intervention of interest
– C Comparision intervention or status
Curriculum Week 2
“The Search Begins” using PICO questions
ANW librarian taught search techniques
Met in Allina computer training room to use Allina
library system
Used PICO questions to develop search term
Learned how to identify the
types of evidence they might find
Not all evidence is equal
End of Week 2
Scholars worked with their
mentors to conduct
systematic searches using
key terms and search
engines
Scholars could categorize
the evidence they had
found in their searches
Requested copies of
Week 3
Scholars spent time reading their evidence
Learned how to critically analyze the evidence
Continued to search
Graded the evidence while re-reading the
evidence with a critical eye
Searched for more evidence using reference lists
from “found” studies
Week 4
Started presenting EBP project back to group for feedback
Group discussions and feedback key component of scholar experience
Planned for what to do with the evidence
– Can it be moved evidence into practice?
– More research needed?
Learned how to plan for implementing EBP change
Planning for 2 week break over 4th of July – Meet with unit councils
– Talk with stakeholders
Worked on EBP form
Week 5
Back from break
Scholars reported on their meetings with unit councils and stakeholders
Refined their EBP project
Identified their conclusions
Week 6
Scholar Presentations
Celebration of Knowledge and Excellence
All day - Presentations open to all nurses (CE’s
provided) and other hospital staff
12 scholars each presented their work in a 20
minute presentation
Outline
– Background
– PICO question
Examples Scholar Questions
Does induced hypothermia therapy reduce mortality and improve neurological outcomes in pediatric cardiac arrest patients compared to standard therapy (normothermia)?
For pediatric oncology patients with an implanted vascular access device (IVAD), does use of sterile versus aseptic technique for access impact patient outcome?
Is the push-pull method of lab drawing as accurate as using the discard method in children with central venous access devices.
In children with antibiotic associated diarrhea (AAD), is treatment with probiotics such as lactobacillus more efficacious than non-probiotic treatment?
Implementation of EBP changes
Ongoing process in collaboration with APRN’s to develop systems for implementation
Example: Inclusion of probiotics on parent education tool on on
antibiotic related diarrhea; inclusion of probiotics on gastro/diarrhea care set
Some recommendations lead to scholar’s involvement in a new collaborations/consortiums
Examples:
– Membership on a Pain Clinical Excellence Team
– Participation in the NACHRI collaboration on central line cares
– Participation in a national clinical trial for hypothermia in pediatric cardiac arrest
Evaluation Process
All 12 scholars successfully demonstrated application of EBP process
Weekly scholar evaluations positive
– Curriculum adapted during course based on weekly feedback
Attendees for Week 6 presentation provided very positive ratings
– Narrative comments on the quality of the presentations
100% attendance of all our scholars
Scholarly, cross-clinical, collegial interactions during work sessions
Graduate school enrollments/applications
Recognition of nursing as both a science and applied
Ongoing Work
EBP Scholar Program featured in nursing publication EBP posters to be presented during Nurses’ week Program scheduled twice in 2010
Ongoing inquiries from staff nurses about
applying to program