Recently, caregiving best practices have evolved from research utilization to an evidence-based nursing construct. Also known as EBP, the construct is widely acknowledged as essential to improving the quality of care delivery and ultimately improving patient outcomes. It’s also acknowledged that the ability to develop strategies that apply EBP’s principles at an optimal level is important to achieving the goals set forth by the construct.
The emergence of EBPs comes at a time where the nursing profession is in a transitional phase. Many nurse practitioners continue to deliver treatment based solely on experience, intuition, and tradition. Because of this, nurse educators and leaders have found difficulty transitioning nurse practitioners from using their experience to complying with EBPs as they become more prominent. However, professionals are increasingly turning to EBPs as guides in the delivery of services and treatment.
To find success with integrating EBPs into a care delivery strategy, nurse leaders can utilize a wide range of strategic elements to build an effective model on a foundation of best practices. Collectively, these components can lay the groundwork that can make a facility’s transition to an EBP construct possible.
Evidence-Based Nursing Practice
Evidence-based nursing practice integrates the latest proven health care research, clinical expertise, and patient needs, as well as cost-saving measures. Nurse practitioners merge these elements into the framework that guides their daily work and assist patients in making informed decisions.
By transforming research into practice, an effective EBP strategy can utilize a holistic approach to care delivery. Ultimately, this approach strives to provide care that meets the moment on several levels, including state-of-the-art health care technology, medical discovery, and patient expectations.
EBP is a concept with many moving parts. Rather than approaching it as a total entity, it’s important for nurse leaders to build a meticulously cohesive strategy that ensures that these moving parts flow together harmoniously. Doing so is key to allowing EBPs to function as intended.
5 Focus Areas
One of the strategies nurse leaders can utilize to integrate an effective evidence-based nursing approach to care delivery is to adhere to the five focus areas set forth by the Collaborative Model of Best Practice, or CMBP. This model is a framework developed by researchers Kaisa Bjuresäter and Elsy Athlin of Karlstad University in Sweden that aids nurses in implementing evidence-based practices.
To test the framework, the researchers implemented it in a study led by nurse educators and leaders focusing on the following five components:
1. Starting the Transition
Evidence-based nursing practice is embedded in the CMBP methodology. When implementing the CMBP, nurse leaders and educators collaborate to encourage, inspire, and support nurse practitioners learning to use the model. This evidence-based process includes five key steps:
- Finding opportunities for improvement
- Research
- Evaluation
- Implementation
- Process monitoring
Overall, participants expressed a positive experience with the process.
2. Team Collaboration
Building rapport among team members is the first priority in launching the process. Perseverance is critical during this stage, as melding personalities is always a challenge. It’s also vital to take steps to ensure early interest in the initiative, taking a special interest in overcoming the objections of resistors.
3. Building Interest
By developing and publishing a clearly defined outline, initiative leaders can help build early interest. This includes precise and sufficient direction regarding the effort. It’s important to disseminate this information when it’ll prove most effective. As an aside, partnership between the participating care provider organization and the academic faculty can foster rapport. It’s also important that nurse leaders actively take part in the overall process, which encourages nurse practitioners to participate.
4. Connecting with Nurse Practitioners
Nurse practitioners found that the guidance provided by the nurse leader made participants feel connected with the process. This was in part due to ongoing two-way communication by the nurse leader. Additionally, nurse practitioners were encouraged by the leader’s positive attitude. This result requires a proactive approach on the part of nurse leaders. However, heavy caseloads sometimes had a detrimental effect on this positive influence.
5. Learning to Teach
Participating nurse leaders felt that the project was a productive and ongoing learning experience. They expanded their body of knowledge and learned new research skills. Due to their limited ability to implement evidence-based practices, the nurse leaders expressed that although the project was rewarding, it was equally challenging. One major positive outcome of the process was enhanced skill in vetting EBP sources.
How to Use Evidence-Based Practice in Nursing
It’s important for nurse leaders to help facilities learn how to execute evidence-based nursing in a care delivery context. If this isn’t done, the full effectiveness of an EBP strategy can’t be realized. This could lessen the concept’s impact on patient care that could in turn hinder a facility’s ability to achieve the goals set forth by an EBP model.
Much like building an EBP strategy, guiding the concept’s execution is a multilayered process. These layers address various components built around different stages of the provider-patient dynamic. At the same time, they’re all connected by the guiding principle of care delivery that can potentially improve patient outcomes.
4 Tips for Delivering Evidence-Based Treatment at Point of Care
Because evidence-based nursing practice touches on different components of care delivery, nurse leaders should develop and execute strategies that address each component directly. Fortunately, they can deploy a few strategies to do this effectively.
1. Professionalism Tips
Assess, Diagnose, Plan, Implement, and Evaluate (ADPIE) is the everyday process for nurses treating patients. For a 24-hour job requiring team collaboration, prioritizing tasks based on deadlines is key. For example, tasks that must be completed within 30 minutes are generally labeled as “must-do” items, while tasks with four-hour deadlines are labeled as “could-do” items but must be completed before the end of the shift.
When nurses feel overwhelmed with tasks, they take a moment to regroup and formulate a viable action plan. It also may help to delegate responsibilities while ensuring that tasks are assigned to the right personnel, under the right circumstance, at the right time, and with adequate oversight.
Experienced nurses take the initiative to inspire team collaboration and assist other less-knowledgeable nurse practitioners. This show of leadership may inspire other veteran nurses to do the same.
To keep their work manageable, it’s important that nurses choose reasonable goals and work toward them. Finally, when caring for traumatized patients, they follow a standard framework: build rapport, treat critical injuries, document patient information accurately, and issue a proper referral.
2. Assessment Tips
Effective assessments start with thinking about how the result will fit into the patient’s overall treatment plan. When conducting abdomen assessments, for example, nurses inspect, auscultate, percuss, and then palpate. The importance of accurately recording the patient’s height and weight is critical. This allows care providers to assess nutritional status, properly prescribe medication, and evaluate body fluid loss or gain when necessary. A nutritional assessment has four sections: health history, laboratory results, physiological assessment, and body dimensions.
When listening to heart and breathing sounds, nurses close their eyes to eliminate distractions. During pupil assessments, they follow the PERRLA framework: Pupils Equal, Round, Reactive to Light and Accommodation. When assessing cognitive ability, nurses follow the CURVES framework: Choose and Communicate, Understand, Reason, Value, Emergency and Surrogate. If a nurse suspects abuse, he or she follows the SEE framework: collect Screening and Evidence information and make the Effort to report the finding to the appropriate authorities.
3. Documentation Tips
Correct documentation is an important facet of evidence-based nursing. When recording patient information, nurses submit only facts and omit any personal opinions. All documentation follows the PIE framework: Problem, Intervention, and Evaluation. When documenting a patient’s reason for seeking care, nurses must be careful to record the statement in the patient’s own words.
If a nurse is unsure if others will understand abbreviations, he or she spells out the term completely. Additionally, nurses avoid using the null sign (Ø). This symbol is on the List of Error-Prone Abbreviations, Symbols, and Dose Designations from the Institute for Safe Medication Practices (ISMP). Instead, nurses use the standard number zero (0) or the word “zero.”
Nurses document procedures immediately after completing them. They record adverse events immediately as well. Finally, nurses must make sure that the document remains secure, as every patient is entitled to privacy.
4. Communication Tips
Effective communication is critical for producing positive outcomes when engaging with patients and their family members and transferring care to other medical professionals. When starting a shift, nurses introduce themselves to new patients and greet existing ones. Nurses then inform patients about what will happen during the shift and review the current treatment plans.
When engaging with patients, it’s important that nurses use clear communication and understand all verbal exchanges. When necessary, appropriate humor may help ease patient concerns. If a nurse suspects abuse, he or she asks open-ended questions, such as “Do you feel safe?” or “Are there times when you don’t feel safe?” Finally, when transferring care, nurses follow the SBAR framework: Situation, Background, Assessment, and Recommendation.
Caring for patients is a central tenet of quality nursing. To produce positive patient outcomes, nurses use evidence-based principles and work together to achieve organizational objectives. More importantly, experienced nurses must take the initiative to mentor new nurses in learning current nursing practices.
Leading the Initiative
During the initiative, the improvement of quality nursing care was the primary objective of nurse leaders. As facilitators, nurse educators chose the leaders to head the initiative due to their sincere interest in delivering this outcome. Another primary goal was to serve as role models for nurse practitioners.
Live practice sessions were an important learning tool, in which nurses had the opportunity to receive positive feedback from their peers. Upon completion of the evidence-based nursing training initiative, nurse educators and leaders expressed high satisfaction with the quality throughout various hospital wards.
Supporting Each Other as Teammates
Nurse leaders cited sincere collaboration as the critical support mechanism of the initiative. This rapport built trust among participants. Nurse leaders consider academic partners as the key to providing leadership in their capacities as both educational and medical professionals. In fact, the academic partners’ continued presence during implementation influenced the resulting positive outcomes and group collaboration. Moreover, nurse leaders greatly appreciated the support delivered by nurse educators.
Upon successful completion of evidence-based practice implementation, nurse leaders must institute an ongoing process to ensure the early adoption of EBPs. Additionally, incoming nursing professionals will learn their practices using this kind of evidence-based framework. The study concurred with the outcomes of other research designed to highlight the changes involved in implementing evidence-based practices in the hospital setting.
Nurse educators and leaders will find a challenge in teaching this relatively new paradigm to a new generation of nurse practitioners. However, the end result will be positive health for the U.S. population.
Lead the Future of Health Care
EBP-based strategies can transform care delivery systems and their ability to administer care that can improve patient outcomes. For nurse leaders, the concept can provide them with the unique opportunity to be an integral part of this transformation as it grows and evolves. This ultimately puts them in a position to help shape the trajectory of care delivery for years to come.
Ohio University’s online Master of Science in Nursing program can help prospective nurse leaders develop the knowledge and skills needed to effectively deploy EBP-driven strategies that make a difference. Our program is designed to give you the tools to be a trusted leader in the health care field as the concept of care delivery continues to change. Learn about how we can take your health care career to the next level.
Recommended Readings
Examining the Impact of the Nursing Shortage on Patient Care
6 Best Practices for Nurse Educators to Teach Patients About Their Health
Sources:
Epomedicine, Patient Decision Making Capacities in Emergencies — CURVES Mnemonic
Healthline, “PERRLA: What It Means for Pupil Testing”
Institute for Safe Medication Practices, List of Error-Prone Abbreviations
Lippincott NursingCenter, Nursing Tips
National Center for Biotechnology Information, “Evidence-Based Practice and Nursing Research”
National Center for Biotechnology Information, “Evidence-Based practice”
Nurse Theory, ADPIE — The Five Stages of the Nursing Process
Online Journal of Issues in Nursing, “Using SBAR to Communicate with Policymakers”
Wolters Kluwer, Nursing Documentation: How to Avoid the Most Common Medical Errors