Evidence-Based Practice. Scholar Fellowship Program For the Bedside Nurse

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Lizbeth Rogers
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1 Evidence-Based Practice Scholar Fellowship Program For the Bedside Nurse 1

2 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

3 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

4 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

5 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*

6 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 Clinics, April 17, 2008

7 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

8 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 Hockenberry, Wilson, Barrera, 2006

9 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

10 Planning for Pilot Program Planning was done over a 12 month period Monthly meetings and frequent 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

11 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.

12 Is this a.. Sacred Cow?

13 OR.

14 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." Thoennissen et al., 2001

15 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.

16 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

17 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

18 Curriculum Schedule 6 eight hour days Met weekly (Tuesdays) beginning in June through July with 2 week break around 4 th of July Mentors present every day Group computer room available with online access for searches

19 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 O Outcome

20 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

21 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 studies from Allina library

22 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 Started enjoying the challenge of the hunt

23 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 4 th of July Meet with unit councils Talk with stakeholders Worked on EBP form Standard form that outlines EPB process

24 Week 5 Back from break Scholars reported on their meetings with unit councils and stakeholders Refined their EBP project Identified their conclusions Learned how to create powerpoint presentations

25 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 Search strategies Evidence Recommendations

26 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?

27 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

28 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 profession ; Knowledge as important to professional practice

29 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 s with new PICO questions Ongoing Work

30 Thank You Mari Akre, RN, PhD, NEA-BC Beverly Clark, RN, BSN, CNOR Mary Langevin RN, MSN, CFNP, CPON, HN-BC Questions?

Beyond the Emerald City. Marjorie C. Dobratz, RN, DNSc. Professor University of Washington Tacoma

Beyond the Emerald City. Marjorie C. Dobratz, RN, DNSc. Professor University of Washington Tacoma Beyond the Emerald City Marjorie C. Dobratz, RN, DNSc. Professor University of Washington Tacoma Background The American Association of Colleges of Nursing (AACN) BSN standards (2009) expect undergraduate