An Evidence-Based Nursing Practice Fellowship: Process and Product. Elizabeth W. Bayley, PhD, RN Louanne A. Stratton, PhD, RN

Transcription

1 An Evidence-Based Nursing Practice Fellowship: Process and Product Elizabeth W. Bayley, PhD, RN Louanne A. Stratton, PhD, RN

2 Nemours Strategic Plan for Research and Scholarly Activity Goal: Become a leading child health system in the nation by 2015 From Bench to Bedside; Clinic to Community Scholarship as component of all health professionals work Defined focus areas for research Bottom up approach with integrated teams of clinicians, bench researchers, educators

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4 Assumption: Nurses are Knowledge Workers

5 Knowledge Worker Roles Analyzing data to establish relationships Assessing input in order to evaluate complex or conflicting priorities Identifying and understanding trends Making connections Understanding cause and effect Ability to brainstorm, thinking broadly Ability to drill down, creating more focus Producing a new capability Creating or modifying a strategy

6 Boyer s Model of Scholarship Discovery Integration Application Teaching

7 Nurses as Scholars Scholarship is: Demonstrated when knowledge is advanced or transformed by application of one s intellect in an informed, disciplined, creative manner. Public; susceptible to critical review and evaluation by peers Accessible for exchange and use by other members of one s scholarly community. Building blocks for knowledge growth in a field.

8 Nurses as Scholars A lifelong commitment to thinking, questioning, and pursuing answers Includes taking risks, testing assumptions Incorporates explaining and applying lessons to practice setting Includes pursuing higher education Clinical performance integrating current research-based knowledge into practice

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10 The Process of EBCP 5 Phases: 1. Ask a clinical question 2. Search for the evidence 3. Critically appraise the evidence 4. Apply the evidence 5. Evaluate the effectiveness of the evidence (Hockenberry et al..ped. Nsg. 32(4), 2006)

11 Iowa Model of Evidence-Based Practice to Promote Quality Care evidencebasedpractice/iowamodel.html

12 Skills for EBCP Asking a question- PICO (population, intervention, comparison, outcome) Literature search- accessing the evidence using electronic databases Evaluation of methodological rigor and relevance of literature Analytical skills & critical thinking Reading with comprehension

13 KAP Study Nursing Shared Governance Research and Education Council goal Nurses Knowledge, Attitudes and Practices Related to Research R. John, J. Prozzillo, E. Bayley Over 700 Nemours RNs surveyed using 33- item tool (Burke et al., Aurora Health System) >50% response rate Results indicated need for increased knowledge

14 Review of Literature Organization/Reference Program /Number of Nurses Time/ Hours Johns Hopkins Hospital, Baltimore, MD Newhouse, RP, Dearholt, SL et al. (2007). Johns Hopkins Nursing Evidence- Based Practice Model and Guidelines. Indianapolis: Sigma Theta Tau Int l. EBP Fellowship Program 2 nurses Nurses given 50% salary support over 3 mos. to work on EBP projects. Approx. 240 hrs. paid time per nurse fellow. Mayo Clinic Hospital, Phoeniz, AZ Pipe, TB (2008). Leadership strategies. J. Nurs. Care Qual., 23(3), ASU Center for the Advancement of Evidence-Based Practice mentorship/index.htm Clinical Practice EBP Mentorship A 5-day immersion program, held at ASU to prepare staff nurses, APNs, nurse researchers and other providers, preferably in teams, to serve as leaders and mentors in changing organizational cultures by promoting, implementing, and sustaining EBP from administration to the bedside. Hospital has sponsored 5 nurses (to date of article) to attend the weeklong EBP mentorship program at Arizona State University to date. 40 hrs plus registration ($2500) for each nurse.

15 Review of Literature University of Iowa Hospitals and Clinics Center for Evidenced-Based Nursing Care and Quality depts/nursing/rqom/ evidencebasedpractice/internship.html UCLA Medical Center, Los Angeles, CA Gawlinski, A. (2008). The power of nursing research. Am J. Crit. Care, 17(4) Evidence-based Practice Staff Nurse Internship Program Staff nurses team with their nurse manager, an APN mentor, and an EBP facilitator. Combines didactic presentation, group discussion, and facilitated work time to support applying concepts learned to their project. Application process. 6 interns every other year. EBP Fellowship Program for Staff Nurses 7 Fellows per year Mentoring for 9-12 mos. by doctorally prepared nurse and a clinical mentor (CNS, Educator or Mgr with MSN) Research Institute Meetings include education and work on specific proposal 18-mo program; 12 meetings per year. Several groups of staff nurses have successfully completed the program which began in The program is being offered on an every-otheryear basis to promote completion of current Intern projects before beginning the next Internship group hr. days (96 hrs.) paid 6 8 hr. classes (1/mo.) 48 paid hrs. for class time per nurse fellow. Unit-based teams of 4-5 staff nurses and at least 1 APN meet twice monthly for 2 hrs each for 12 months. Additional 4 hr. meetings held periodically 48 hrs. for monthly twice monthly meetings plus additional hrs. for periodic meetings (estimate)..

16 Review of Literature Vanderbilt University Medical Center Wells, N., Free, M., & Adams, R. (2007). Nursing research internship. JONA, 37(3), Nursing Research Internship Program 10 interns completed the 2 year program. 1 day/month for 2 years used formal curriculum. 1st year involved mostly classes or workshops each day. 2 nd year was mix of class time and time to work on actual projects during the class day. 24 paid days per nurse. Cincinnati Children s Hospital Presentation at Society of Pediatric Nurses Annual Conference, 4/09 by Lisa E. Long & Myra M. Huth Point of Care Scholar Program Curriculum includes processes of EBP and conduct of research. Scholars report qrtrly to Nsg. Professional Inquiry Council; poster and conf. presentation. 6 nurses per year 8 hours per week for one year 52 paid days per nurse per year Application process (includes interview; recommend. letters); for direct care providers; 0.7 or >FTE.

17 Review of Literature York Hospital, York, PA Mooney, B. (2009) Two in One. Advance for Nurses May 11, p EBP/Nursing Research Fellows Program 2 Fellows per year 16 hrs./week for 12 weeks. 192 paid hrs.per fellow Virginia Commonwealth University Health System, Richmond, VA Selig, PM, & Lewanowicz, W. (2008). Translation to practice; developing an evidence-based practice nurse internship program. AACN Advanced Critical Care, 19(3), p University of Rochester Medical Center Strong Memorial Hospital, Rochester, NY Highland Hospital EBP Nurse Internship Program Year 1-9 month program culminates in poster display of literature review. 8-hr. initial workshop and monthly 90 min. meetings/classes. Year 2- Based on literature review, may be mentored in practice change based on evidence. Research Internship One year program designed to expose nurses to research and EBP and provide mentored opportunity to complete EBP or research project 2 yr. program Paid class time == at least 22 hrs. Additional time to work on project is paid. One paid day per month for full year. (96 paid hrs. per nurse)

18 AIDHC EBNP Fellowship Program Proposal Purpose: To promote the use of evidence by professional nurses to improve patient outcomes. To help nurses learn the essential steps in the process of EBNP and research. To enhance nurses ability to engage in the scholarship of discovery, integration, application and teaching.

19 Administrative Support Proposal submitted to CNO by Director of Nursing Research CNO sought support from COO, CEO, CFO Budget Approval for 17 Fellows for 12 paid 8-hr days in 2010 Textbook purchased for each Fellow: Melnyk, B., & Fineout-Overholt, E. (2010) Evidence-Based Practice in Nursing and Healthcare. 2 nd ed. Wolters Kluwer/ Lippincott/Williams & Wilkins

20 Role of Research and Education Council Guided development of program structure Reviewed curriculum proposed by Director of Nursing Research Reviewed and approved applications Received regular reports of program implementation Reviewed evaluation of program

21 AIDHC EBNP Fellowship Program 12 days of didactic instruction and independent work time scheduled over 8 months Commitment from Fellows for an additional day or > per month working on project Classes scheduled at 3-4 week intervals from May 11 to December 17, 2010 Classes provided primarily by Director of Nursing Research with guest lectures by 2 CNSs (R. Lebet, D. Brecher), UDEL professor (Dr. J. Herrman) Medical Librarian (K. Flathers) provided essential support with individual help for searching literature.

22 Marketing the EBNPF Program

23 Marketing the EBNPF Program

24 EBNPF Application Process Application form, including past EBN/research experience; project ideas Letters of recommendation and support from manager and MSN-prepared mentor Experience and AIDHC employment criteria BSN desirable Resume

25 EBNPF Curriculum: The Process of EBNP Nemours Research Strategy The Nurse as Scholar Evidence-Based Nursing Practice: What It Is and What It Is Not Models for EBN Research vs. EBNP vs. QI Defining an EBP or Research Problem or Question Evidence Rounds Planning and Evaluating Outcomes of Nursing Interventions and Practice Changes Evaluation Designs

26 EBNPF Curriculum: The Process of EBNP Planning and Implementing a Change in Practice; Models and Strategies for Change Forming Teams for Research and EBNP Diffusion of Innovations Strategies for Championing EBN on the Clinical Unit Exemplars of EBNP Projects Implementation Science TeamSTEPPS A Process for Implementing Evidence-Based Clinical Practice

27 EBNPF Curriculum: Accessing, Reviewing, and Appraising Evidence Essentials of Searching the Literature Introduction to InfoLink Anatomy of a Research Study- Reading Published Research Appraising the Literature and Developing an Evidence Table Hierarchy of Evidence Guidelines for Critique of Research Literature Guidelines for Critique of Clinical Literature Meta-Synthesis Meta-Analysis

28 EBNPF Curriculum: Research Design and Process Research Design Overview; Sampling, Setting, Methods Qualitative Research Methods Quantitative Research Methods and Designs Triangulation Measurement: Selection and Development of Instruments for EBN and Research; Reliability and Validity Data Collection Exemplars of Nursing Studies Funding Research

29 EBNPF Curriculum: Ethics of Research and Human Subject Protection Human Subject Protection: CITI and Nemours University Programs History of Ethics in Research: The Deadly Deception Navigating the Clinical Research Review Committee and the Institutional Review Board Nurse s Role in Clinical Research

30 EBNPF Curriculum: Data Management and Analysis Data Management and Security for Research, Quality Improvement, and Evidence-Based Practice Planning for Data Analysis Interpreting and Summarizing Findings Statistics for Healthcare Research: - Level of Measurement - Hypothesis Testing - Probability - Power Analysis Statistical Tests Descriptive Statistics Analysis of Associations: Chi square Analyzing Relationships: Correlation Analyzing Differences: Variance t-test Analysis of Variance Factorial Analysis Analysis of Covariance Multivariate Analysis of Variance Analyzing Complex Relationships: Multiple Regression Biostatistics: Survival Analysis; Odds Ratios

31 EBNPF Curriculum: Presenting Scholarly Work Writing an Abstract Podium Presentations Designing a Poster Using PowerPoint for Presentations and Posters Writing for Publication Oral and Poster Presentations of EBN Projects or Research Proposals

32 Program Assignments Date Due Read the following Chapters in Melnyk and Fineout- Overholt s Evidence-Based Practice 6/1/10 Chap. 3-1 st ed. Assignments Evidence-Based Practice Project Review textbook chapters and articles as assigned plus: Assignments Research Study Review textbook chapters and articles as assigned plus: 6/23/10 Chap. 4, 5-1 st ed. 7/21/10 Chaps. 1,2, 6,9,10 8/10/10 Chaps. 7,8,20 Write up evidence-based practice searchable question. List keywords used in literature search. Draft table of evidence review with reference list. Describe current practice and proposed change in practice Write up research question(s). List keywords used in literature search. Write problem statement. Draft literature review table with reference list. Write Introduction and review of literature sections.

33 Program Assignments 9/7/10 Chaps. 11,12 Write review of literature Write Framework section (A (optional), B,C,D, 9/29/10 Chaps. 15, 17 Write Resource requirements and implementation strategy 10/19/10 Chaps Refine all of above and draft evaluation section. Write Methods section A, B, C, D Refine all of above and write Methods section E and F 11/5/10 Chap. 14 Refine implementation strategy and provide evidence of collaborations/logistical components. Implement baseline evaluation information collection. Write Appendices Write Methods sections G,H, I, J 11/15/10 Chap. 16 Begin implementing EBN practice change 12/3/10 Draft poster and outline of oral presentation. Refine all of above (Draft 2 or 3) Draft poster and outline of oral presentation. 12/17/10 Give poster and oral presentation Give poster and oral presentation

34 Issues in Implementation Finding class space for ideal schedule Fellows missing classes usually due to previously scheduled time off or unit need for staffing on class days Scheduling time for individual meetings with Fellows sometimes difficult for Director Nursing Research Keeping up with the reading and program requirements

35 Project Topics Obtaining Tobramycin Levels in Patients with Cystic Fibrosis Procedural Pain Management for Infants with Congenital Heart Defects The Use of EMLA Cream for Procedural Pain Relief in Children Hemostatic Dressings for Femoral Access Sites in Percutaneous Cardiac Catheterization Procedures

36 Project Topics The Effect of Healing Touch Therapy on the Adolescent with a Gastrointestinal Medical Condition Transitioning to an Evidence Based Protocol for the Infusion of Infliximab (Remicade) in a Pediatric Ambulatory Care Setting Compassion Fatigue: Nothing Left to Give Assessing the Comfort Level of Bedside Nurses Implementing Sedation Protocols

37 Project Topics The Healing Touch Program in the PICU A Comprehensive Oral Care Protocol for Patients at Risk for VAP in PICU EBN Protocol for Infection Reduction in the PICU Child Abuse: Nursing Assessment and Intervention

38 Project Topics Sedated Children: Oxygen or Not Fever: Friend or Foe Parental Satisfaction with Preoperative Assessment and Education CPR in the NICU for All Families

39 Evaluation Baseline and at End of Program KAP Tool- 33 item instrument that measures Knowledge, Aptitude, and Practices related to research/ebp UG Competencies- Likert-type scale applied to Undergraduate Competencies for Evidence-Based Practice (U. TX Acestar Essentials) Mid-Program End of Program Overall Program Evaluation Tool; KAP, UGC Occasionally 5-Minute Feedback Form Implementation and Dissemination Activities

40 Plan for 2011 Modify curriculum based on 2010 evaluations Apply similar marketing and application process Engage more nurses from units that did not participate in 2010 Increase mentor communication and support

41 2011 EBNP Fellowship Program 15 nurses applied and approved 6 new units represented 7 new mentors Classes began on March projects will be presented December 9 in podium and poster session