Evidence-based practice, a crucial competency for healthcare providers and a basic force in Magnet hospitals
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Evidence-based practice, a crucial competency for healthcare providers and a basic force in Magnet hospitals, results in better patient outcomes. The authors describe the strategic approach to support the maturation of The Johns Hopkins Nursing evidence-based practice model through providing leadership, setting expectations, establishing struc- ture, building skills, and allocating human and material resources as well as incorporating the model and tools into undergraduate and graduate education at the affiliated university.
Evidence-based practice (EBP) is an essential com- ponent of professional nursing,1,2 a crucial compe- tency for healthcare providers,3 and a basic force in Magnet hospitals4 and results in better patient out- comes and higher levels of nursing autonomy.5
Fostering EBP within organizations requires strong infrastructure, including nursing leadership and hu- man and material resources.6-10 Several organizations have reported on the use of EBP change models to assist and mentor individual EBP project teams.11-14
One recent publication discusses the use of a change model in the context of organizational change, highlighting the establishment of an EBP committee that is positioned within the nursing department’s administrative structure.15 Approaching the imple- mentation of EBP as an organizational transforma- tional change frames the approach strategically.16
After the creation and testing of a conceptual model for EBP,17 a strategic plan was developed to implement the Johns Hopkins Nursing EBP model and guidelines (JHN EBP) throughout the organi- zation. The team knew that the implementation of EBP would require a substantial change in nursing culture. The goal was to infuse the use of JHN EBP into routine practice within each department. This goal required a number of strategic objectives that included developing EBP education programs and Web-based resources, modifying job description cri- teria to include behavioral outcomes for EBP, defin- ing the origin of potential question generation, and building nurse EBP skills and expertise (Table 1). The EBP program was built through providing lead- ership, setting expectations, establishing structure, building skills, and allocating human and mate- rial resources. The JHN EBP model and tools were then incorporated into undergraduate and graduate education at the affiliated university. This article describes the strategic approach to building infra- structure to support the maturation of EBP within an academic medical center.
Leadership
Leadership endorsement was the initial step in building the EBP program. Nurse administrators are responsible for managing both human.
Authors’ Affiliations: Assistant Dean, Doctor of Nursing Practice Studies and Associate Professor, University of Maryland School of Nursing, Baltimore, Maryland (Dr Newhouse); Assistant Director of Nursing, Neuroscience, and Psychiatry (Ms Dearholt); Assistant Director of Nursing, Clinical Quality (Dr Poe), Nursing Administration, The Johns Hopkins Hospital, Baltimore, Maryland; Professor of Nursing (Dr Pugh), York College of Pennsylvania, York, Pennsylvania; Associate Professor and Director, Master’s Program and Interim Director, Doctor of Nursing Practice Program (Dr White), The Johns Hopkins University School of Nursing, Baltimore, Maryland.
Doctor Newhouse was Nurse Researcher at Johns Hopkins Hospital and Associate Professor at Johns Hopkins University School of Nursing.
Doctor Pugh was an associate professor at the Johns Hopkins University School of Nursing.
Corresponding author: Dr Poe, The Johns Hopkins Hospital, Department of Nursing Administration, 600 N. Wolfe St., ADM 220, Baltimore, MD 21287 (spoe@jhmi.edu).
Material resources necessary for the successful implementation of the EBP program.
Leadership is critical to build organizational readiness for change.16,18 This nursing department is part of a highly decentralized organization. A director of nursing, an administrator, and a physician director lead each department with responsibility for the service area. Because of their accountability for resources, it was essential that the directors of nursing were committed to the EBP implementa- tion goals. The strategic plan was approved by leadership and the governance committees (stan- dards of care [SOC], standards of practice, nursing clinical quality improvement, staff education, and research committees) and was then incorporated into the committee structure.
Establishing the Structure
To establish a structure for building and sustaining EBP, a majority of the governance committees were charged with specific responsibilities. These gover- nance committees include committee chairs, SOC, standards of practice, nursing clinical quality improvement, staff education, and research. Com- mittee chairs consist of the chairs and cochairs for each of the governance committees. Committee chairs drafted EBP committee goals that were aligned with the purpose of each committee. Each committee then reviewed and revised or supported these goals. In addition, the purpose and functions of each committee were reviewed in light of the EBP initiative. During implementation, each
Table 1. Strategic Plan to Infuse The Johns Hopkins Nursing Evidence-Based Practice (EBP) Model
Objectives Responsibility
Build local experts through the following Central committees
1. Each functional unit will complete 1 EBP project using The Johns Hopkins Nursing EBP Model and Guidelines.
2. Central committee members (research, standard of care, education, and nursing clinical quality improvement) will collaborate on choosing the practice question, leading the EBP process, recommending the practice changes if indicated, assuring that the implementation occurs, and evaluating the outcome of the project.
3. Functional units will develop a practice question and identify EBP team members in consultation with central committee representatives.
4. Functional units will create a plan for staff education, format selecting from the options listed below.
Develop EBP education programs EBP core members
Target: trainers 1. Small group rapid cycle or 1-day training 2. Train the trainer competencies (health stream)
Target: staff Mandatory health stream training is dependent on job description. EBP core members with
committee approval
1. Health stream Module 1: Introduction (history, definitions, model, and practice question)
Module 2: Searching evidence (defining terms, sources, and technique)
Module 3: Evaluating the evidence (rating, summarizing, and recommending practice changes)
Module 4: Implementing practice changes
Optional training if desired
2. Health stream plus day practicum 3. One-day workshop by core mentors and trainers scheduled by functional unit
Develop Web-based resources for all nursing staff to access EBP core members
1. Model and guidelines (manual)
2. Tools (practice question, rating scales, critique summaries, project management guide, and evaluation) Modify job description criteria to include behavioral outcomes for EBP Standards of practice
1. Nurse clinician IVobjectives related to module 1 2. Nurse clinician IIM and EVobjectives related to modules 1-3 3. Nurse clinician IIIVparticipation in 1 EBP project per year (modules 1-4)
Define origin of potential question generation EBP core members
Problem prone/high-risk clinical processes or diagnosis, evidence to support the practice challenged, or high variations in practice or outcomes.
Build EBP competencies Nursing administration/ departments1. Require module 1 for all current registered nurses (RNs) in 2006.
2. Require module 1 for all newly hired RNs within the first year of employment.
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Copyright @ Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Copyright @ Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Committee in the governance structure had respon- sibility for a specific goal (Figure 1). The SOC committee became responsible for reporting prog- ress and monitoring outcomes of the EBP initia- tives within each department. This structure was important because it infused the responsibility for EBP across the professional governance commit- tees, making nurse leaders on the committees accountable for growing and sustaining the EBP program. To continue to enhance EBP expertise and engagement, each department is completing at least 1 project over a 15-month period.
Developing an EBP Skill Set
One of the most important steps in the plan was to develop EBP experts that would act as future mentors. These individuals were to be the primary champions and facilitators of EBP. They were members of the governance committees; thus, incorporating EBP goals into responsibilities as a committee member was well aligned with moving the strategic initiative ahead.19
In addition, nurse schedules needed to accom- modate time away from clinical responsibilities for initial training and then later to complete the EBP process. The buy-in from nursing leadership was essential to support nurse scheduling to meet the training requirements, provide the needed encour- agement, and assure that the EBP projects were focused on an important area for which practice recommendations were needed.