This week’s graded discussion topic relates to the following Course Outcome (CO).

• CO1 Applies the theories and principles of nursing and related disciplines to individuals, families, aggregates, and communities from entry to the healthcare system through long-term planning. (PO 1)

What are some of the models and frameworks of EBP currently in use? How does the strength of the evidence determine translation into practice? Why is it important to integrate both evidence-based practice and patient and family preferences? What is the nurse’s responsibility when EBP and patient and  family practice do not match?

Nursing models and framework were developed to organize and understand Evidenced-Based Practice (EBP). According to Stevens (2013), these frameworks are used as guides the design and implementation changes through critical thinking in decision making.There are forty-seven prominent EBP models that are grouped into four themed area (Mitchell, Fisher, Hastings, Silverman & Wallen, 2010):

1. Evidence-based practice and knowledge transformation processes
2. Strategic change to promote adoption of new knowledge
3. Knowledge exchange and synthesis for application and inquiry
4. Designing and interpreting dissemination research.

According to Chamberlain College of Nursing (2018) there are several nursing models that are specifically designed for nursing situation, these include the Johns Hopkins Nursing Evidence-Based Practice Model (JHNNEBP), The Stetler Model, Advancing Research and Clinical Practice Through Close Collaboration (ARCC) model, EBP Iowa Model, the Promoting Action on Research Implementation in Health Services Framework (PARIHS) model and The ACE Star Model.

Incorporating EBP in nursing practice is important because it focuses on improving health care quality in order to increase positive outcomes through the consistent use of research-based knowledge. According to the American Nurses Association (2015), EBP promotes the asking of questions, utilizing models and research to translate and shaped questions and theories into new knowledge.  Integrating both evidence and practice and patient and family preference is significant because EBP is about improving patient care, without patient and family involvement any changed may not translate into success in patient satisfaction. When making decisions for change, all outcomes must benefit and not compromise safety of patients, families, health care providers and organizations.

My responsibility as a nurse, it to deliver high-quality patient-centered care by utilizing EBP to optimize health outcomes for patients and families. When EBP is not matched, patients health may be compromised, patient safety may be at risk, length of hospital stay increase and patients readmission to the hospital may also increase. As nurses, we abide by the standards of nursing practice, the standard of professional performance and practice competent level of nursing by demonstrating the use of critical thinking to deliver high-quality patient care. We need to listen to our patient, identify problems, and be motivated to promote and implement change and be an advocate for our patients and families to provide high-quality care.

References:

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.

Chamberlain College of Nursing. (2018). NR-451 Week 1: Establishing Differences in Research, Evidenced- Based Practice, and Quality Improvement Projects [Online Lesson]. Downers Grove, IL: DeVry Education Group.

Mitchell, S.A., Fisher, C.A., Hastings, CE, Silverman, L.B., Wallen, G.R. (2010). A thematic analysis of theoretical models for translational science in nursing: mapping the field. Nursing Outlook, 58(6), 287-300. doi; 10.1016/j.outlook.2010.07.001

Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 18(2), manuscript 4. doi:10.3912/OJIN.Vol18No02Man04. Retrieved from https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/1449497144?OpenUrlRefId=info:xri/sid:wcdiscovery&accountid=147674 (Links to an external site.

References:

American Nurses Association . (2015). Nursing Scope and Standards of Practice 3rd edition. Silver Spring: ANA nursingworld.org.

I agree there has been a lot more of focus on family involvement when it comes to patient care. I have seen it a lot in culturally diverse patients. We learn through EBP that transcultural nursing is very important when it comes to providing patient care to these patients. We need to involve the family in their care because we all share the common goal to improve the patient health. And through the same goals, we are able to improve patient care and patient satisfaction.

I agree when you mentioned that family involved in patient care is definitely a positive outcome for the patient. I have seen so many patients improve by the simple fact of having a supportive family member at bedside. Assisting them to walk, encouraging them to get well so they can go home, eating and helping them with ADL. Patients feel more comfortable with a caretaker than a stranger. Because of EBP quality and significant improvement in patient care have been proven. Great job on you post/discussion.

Christina

I also agree that without patient and family involvement in the entire process their can be no real success. EBP is a invaluable tool that combined with patient and family wishes and understanding can move care forward. It is due to their understanding of the evidence that assist them in being more compliant with their plan.

Hi Class,

Scott

Professor,

I work nightshift so I don’t see many physicians doing their actual rounds but there are a few physicians that make their rounds before 6 am. These physicians do ask the nurses for their assessments of the patients plan of care and implement their suggestions which is nice to see.

Deanna Kilvitis

Great points! I could not agree with you more on this. As nurses we do the spend most of the time with patient. It is important that there is a great rapport between physician and nurses to promote collaboration. Nurses do function autonomously with a clear distinction of its scope of practice as a result, physician will value the nurses expertise as well as being the patient advocate. It is nice to see when a physician seek a nurse’s opinion regarding the patient care and treatment plan. I have witnessed this myself when a physician says ” I trust your judgement” it is so empowering to hear this.

Thanks,

Kristine

At my hospital and especially in my unit our nurse educator has made evidence-based practice the thing to go on.  Our big project now is to integrate nurse-led rounding in our interdisciplinary rounds.  The whole interdisciplinary team is all for it and it is a work in progress.  We also have comities in our unit, and the evidence-based practice and clinical practice comity work hand in hand to improve our nursing practice.  In terms of family preference and ebp and patient preferences, there is always some tension.  At the end of the day, we do what is best for our patients.  We educate our families as much as possible to point them to the best course for their children’s well being.

Stevens, K. R. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. Online Journal Of Issues In Nursing, 18(2), 1. doi:10.3912/OJIN.Vol18No02Man04

You spoke about families and children, so I am assuming that you work in a pediatric area. I work in a Newborn ICU and we label ourselves as “family friendly”. When the babies are moved from the open bay admission areas to private rooms, the parents are allowed to stay in the room with their baby 24/7 if they would like to. Nearing discharge we encourage them to do so. We rarely have “tension” with family preference and EBP. I think that educating them from the very beginning and giving them the “power” to be parents and the baby’s advocate along side of us makes the difference. We call them part of the team and encourage them to voice their thoughts, opinions and preferences daily as well as participate in multi-disciplinary rounds weekly, We find the more we listen, the more they listen to us and EBP. I am not saying that we always agree, (the staff and the parents) but if their preferences are not dangerous, we often go with their preferences. Believe it or not, it often works out best for everyone. Evidence works for most, but some need it adapted to suit their preferences within reason. (and of course safety)

Wendi Keller

Evidence based practice dates back to Florence Nightingale, yet it took a long time for nurses to conduct nursing research. So why is it important for nurses to have their own body of knowledge? Can any of you give or think of a specific example of how bedside nurses contribute to nursing research?

Scott

Bedside nurses contribute to nursing research in a few ways. First of all, we are usually the ones to identify an issue or problem that needs more information and solutions that can be found in research. We contribute to research by being part of it at times. Whether we are collecting data or assisting in the process of the research, we contribute. Bedside nurses also utilize and validate research by using it in EBP. We analyze and integrate research into our procedures, policies and protocols in order to provide our patients with the very best outcomes.

Wendi Keller

Hello class

Rebecca

I should have rephrased my statement when I said there is sometimes “tension” in my unit.  I work in a pediatric CVICU, so there are some ground rules that parents and family members do not like.   Yes, they are allowed to visit their kids 24/7 barring anything like bedside procedures and immediate post OR time periods.  There is sometimes tension when not all staff adhere to enforcing our rules, for example, no eating in the patient room, limiting visitors to 2, no children under 12, no sick people in the unit and strict handwashing.  When you attempt to enforce the rules sometimes you get the “Oh, no one told me this” and that security let their small child or sick family member through.  But that comes with the territory of being in a pediatric CVICU with 24/7 visiting hours.

Alexander,

Wendi Keller

It was very interesting to read your post about your position in the NICU. At my facility, we just opened up a new “Mother-Baby Unit” and it is set up so the newborn is always in the room with the mother and there is not a nursery anymore. I think that is great! I am sure they had done their research using EBP on the outcome of the newborns and parents that used these types of rooms compared to newborns in a nursery.

Our newborn nursery has been keeping the babies in the mothers’ rooms for a bit. Keeping a 24 week gestation preemie (you know – about 500 grams!) in a private room was met with much skepticism. I agreed with the questions and was very concerned for safety. I must admit that it continues to have its challenges, but we are working them through as the research tells of the benefits for the baby. We are a very EBP unit and eventually hope to acquire magnet status for our children’s hospital.

I enjoyed reading your post. It our job as nurses to keep our patient’s health and happiness our top priority. Nurses want to deliver the very best care possible to their patient. Therefore, when the patient or families preference does not meet the current EBP it can cause some issues. It is crucial for nurses to find the balance needed to provide not only the treatment the patient wants but the treatment that is best for the patient. After all, we want to make sure new evidence is implemented in the clinical setting as our ultimate goal is to improve patient outcomes. Thanks for sharing!

Edlyne

The nurse/patient ratio is a serious concern and now evidence-based practice literature is providing an impetus for change that can no longer be ignored. For far too long nursing has been the area when institutions can make cuts to save money. Although budgets are tight and solvency may even be a concern in many places, the evidence is mounting that in order to produce the results that are not only right for patients but are also being required by payers, nursing must be adequately funded.

In what ways do you think you may be able to help enlighten leadership in your workplace to the evidence available on this issue?

Hi Alex:

The professional practice council (PPC) committee examines some of the data and tries to find ways to curtail issues by staff education using EBP to acquire better patient care outcomes. Nurses need to demonstrate leadership as they strive to provide quality, safe care, advocate for patients/families, and have their work and accomplishments recognized as a being important to the healthcare team, (Finkelman, 2016, p. ix).

References

American Nurses Association (ANA). (2015). Scope and standards of practice (Vol. 3). Silver Spring, MD: Author.

Finkelman, A. (2016). Leadership and management for nurses: Core competencies for quality care (3rd ed.). Boston, MA: Pearson.

EBP is essential and paramount to delivering effective care that promote the optimal patient outcome. It is to our benefit as nurses to have this available resources now to based our practice and to  back us up with the theory that it has been proven to be effective. As the nursing profession continues to becoming more scientific based,  it is imperative that we as nurses continue to learn and grow with it. It is also our responsibility to educate our patient for better understanding of the care being provided. Great post.
Thanks,

Kristine

Nursing knowledge is important so that we can develop adequate knowledge to provide our patients with quality care. It’s important so that we may continue to problem solve and critically think how we can evolve in the nursing profession while maintaining safe and quality care to patients.

Scott

It is important to integrate both EBP and patient and family preferences because the bottom line is, it improves the delivery of healthcare and patient outcomes, as well as providing safe care. In caring for patients, the healthcare provider, the patient and the family are all pertinent in delivering the highest quality of care to the patient.  I apply this concept every day when at work. I encourage the family and the patient to be a part of their plan of care. I witness the huge impact this has on the outcomes of patients. Especially when the patient and family are both educated and understand the disease process.

The most important responsibility of the nurse when EBP and patient and family practice do not match is to treat them with respect and dignity, share knowledge and information, encourage participation, and collaborate together to have the best patient outcome. Listening to the patient and family is imperative as well.  The final goal is to keep patient safe and provide the highest quality of care to our patients.

References:

Nursing, C. C. (2018). NR451 Week 1: Establishing Differences in Research, Evidenced Based Practice, and Quality Improvement Projects. Downers Grove, Illinois.

I enjoyed reading your post. With so many models and frameworks out there to choose from it’s no wonder how nurses can become overwhelmed with the process of selecting the right one for their scenario. In your post you mentioned Ace Star Model. It certainly does appear that this one was designed with the nurse in mind. After all, we want to make sure new evidence is implemented in the clinical setting as our ultimate goal is to improve patient outcomes. I believe nurses should educate patients on the evidence and associated outcomes, and provide evidence based care that best fits the patient’s preferences.

Edlyne

Stevens, K., (May 31, 2013) “The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4.

NR451 RN Capstone Week 1

Types of Nursing Models and Frameworks of EBP

Discussion Thread

In 2001 The Institute of Medicine proposed that there was a significant gap in what we know about patient care and how we care of patients. The EBP movement began and continues to address excellence in nursing care based on the latest evidence (Stevens, 2013). In our first week’s lesson, models of evidence-based practice (EBP) were introduced. A model provides a guide for nurses when they change practice based on EBP. The nursing models reviewed in this week’s lesson are – the Johns Hopkins Nursing Evidence-Based Model, the Stetler Model, the Advancing Research and Clinical Practice Through Close Collaboration, EBP Iowa Model, the Promoting Action on Research Implementation in Health Services Framework (PARIHS), and the ACE Star Model of Knowledge Transformation. (Chamberlain College of Nursing, 2018) Nurse scientists formulate models to help organize EBP. Models help nurses to design and implement EBP decisions to support our nursing practice while also increasing the quality of care and safety for patients (Stevens, 2013; Lusardi, 2012)

EBP models contain similar elements and one should choose the model that best suits the type of practice change and the clinical area in which it will be implemented. The elements in a model start from the initial clinical issue or problem to implementation and evaluation of the practice change. The Iowa Model is an organizational model that focuses at the organizational level. It includes conduct and the use of evidence. The Johns Hopkins Model is a change model helping the translation of evidence into practice. A focused model, the Stetler Model gives steps to assess and use research appropriately in practice (Lusardi, 2012). Focusing on critical thinking, the evidence may have expert consensus and quality improvement also. The strength of the evidence would determine that it indeed could make a difference and translate into an improved practice. It is important that both EBP and patient/family preferences align. As a patient advocate, a nurse can explain and educate a patient, but if the patient does not understand or find it valid in their life, it will not provide the best outcome. A nurse’s responsibility is to educate and allow the patient to choose the practice that makes sense to them for not only compliance, but for the best outcome. At times a patient does not agree with the “best” option for their care. While a nurse may honor the patient’s view, he/she also has the responsibility to continue the dialogue and education while understanding why the patient made that choice. Often the patient may enlighten the nurse to a possibility that was never introduced or explored. It is then that the nurse and the patient can collaborate to find a common ground. To truly improve patient care and safety, the EBP must suit the population as well as the individual to be successful.

References

Chamberlain College of Nursing. (2018). NR451 RN Capstone Week 1: Establishing Differences in Research, Evidence-Based Practice, and Quality Improvement Projects [Online Lesson]. Downers Grove, IL: DeVry Education Group

Lusardi, P. (2012). So You Want to Change Practice: Recognizing Practice Issues and Channeling Those Ideas. American Association of Critical-Care Nurses, 32(2)m 55-64. doi: http://dx.org/10.4037/ccn2012899 (Links to an external site.)

Stevens, K. (May 31, 2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. OJIN: The Online Journal of Nursing, 18(2). doi: 10.3912/OJIN.Vol18No02Man04

Submitted by Wendi Keller

It is very important for us as nurses to have our own body of language. It sets us apart from medicine as it defines us a profession rather than just the help. We have more control over our patient care and become important members of the interdisciplinary team. Having our own voice (so to speak) also helps us to get paid because it validates what we do for the patient. In regards to bedside nurses and their role in the research part of patient centered care, nurses at the bedside are at the forefront of almost every patient actual and/or potential problem. We are the advocate for the patient. If something goes wrong, we can identify it first and bring concerns to the right team member so solutions can be tested and made effective for our patients. If we continue to treat the nursing profession as one that stands out in this manner we will be able to provide quality care to all our patients.

Scott

Professor and class,

With ever changing healthcare policy and medical advancements, it is imperative that today’s professional nurse be motivated to participate in research and evidence based practice. Although EBP has many layers and may seem complex or time consuming for the already the overworked staff nurse, it is vitally important because the increased knowledge gained leads to safer, more efficient and quality care. Evidence based practice helps to increase confidence and improve critical thinking skills, which ultimately changes practice and improves our clinical performance.

Nursing models give us direction and are what we will use to change practice (CCN, 2017). Our lesson this week gives us an overview of a few of the forty-seven prominent EBP models that have been identified, and are used to guide the design and implementation of approaches intended to strengthen evidence-based decision making (Stevens, 2013).

The Johns Hopkins Nursing Evidence-Based Practice Model (JHNNEBP) utilizes a three-step process (PET) for clinical decision-making. This model provides a clear outline for conducting an EBP examination.

P: Practice question: is the development of the EBP question, recruiting a team, identifying the stakeholders and assigning team leaders and responsibilities.

E: Collection of evidence: this step is to conduct a search for evidence, appraise the evidence for strength and quality and develop recommendations for change based on the evidence.

T:  Translation of the evidence to use in practice: this is done by determining the appropriateness of the recommendation, then, develop and implement an action plan and report the outcomes to the stakeholders (Stevens, 2013).

The EBP Iowa Model highlights the importance of considering the entire healthcare system from the provider, to the patient, to the infrastructure, using research within these contexts to guide practice decisions (Dontje, 2007).

The ACE Star Model of Knowledge Transformation is defined as an interdisciplinary approach for translating research into practice and attaining quality improvement (CCN, 2017). This model is a simple, comprehensive approach to translating the evidence into practice. This model directs the researcher to consider a summary of the gathered knowledge and the relevance in clinical decision-making (Stevens, 2013).

EBP involves applying the various ways of implementing evidence, which comes out of research in medical, nursing and other scientific areas. Real scientific evidence closes the gap between practice and theoretical hypothesis. For research to be considered reliable and valid, researchers must conduct systematic, scientific inquiry and determine if the results are helpful in caring for patients.

It is just as important to integrate patient and family preferences because it has been determined that healthcare workers and medical facilities that practice patient-centered care have improved patient clinical outcomes. Patient-centered care means that the care is customized and reflects the patient’s needs, values and choices, it also includes families as an essential part of the care team. The social and cultural factors of each patient must be taken into consideration when determining the direction of care.

Nurses have the responsibility to improve patient knowledge. Sharing the evidence-based information and allowing the patient and their family to make decisions based on that knowledge is part of the patient-centered care model. The patient is always a member of the team, and sometimes what might be optimal, scientific-based care may not be what the patient or their family wants. Nurses would provide an environment that delivers empathy and compassion and respect for the patient and their family. Desires of the patient should be discussed with all of the healthcare team so that awareness and comprehension of the situation is recognized and respected.

References,

Chamberlain College of Nursing. (2017). NR451 RN Capstone: Week 1 lesson. Downers Grove, IL: Online Publication.

Dontje, K.J., (2007) “Evidence-Based Practice: Understanding the Process.” Topics in Advanced Practice Nursing eJournal. 2007; 7(4) © 2007

Stevens, K., (May 31, 2013) “The Impact of Evidence-Based Practice in Nursing and the Next     Big Ideas” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4.

Professor,

Yes, the nurse is the one who spends the most time with the patient. The nurse gets to know each patient individually and is able to identify certain things about the patient. Nurses are advocates for the patients. I like to say, “we have their backs”.

I’ve had several incidents in my nursing career where if I didn’t use my knowledge and critical thinking skills, the patient could have been harmed.  I recently had a patient 2 weeks ago who was ordered to receive Cytoxan. (this would be my first time meeting this patient). The order read to infuse 135mg, which is not an unusual dose.  However, prior to the patient coming for her infusion, I looked into her history.  What I found was that she was a new Dialysis patient and her last Cytoxan dose that she received  had only been 60mg. Once I realized the dose difference, I then called the physician and clarified all of the orders. He was very grateful that I found the error. The outcome could have been awful. The bottom line is, it is our responsibility as the nurse to protect and advocate for our patients.

Scott:

Many times this has happened. I was always taught to trust my “gut” and I know encourage younger nurses this as well. Experience and time can hone our critical thinking skills as well as having an open mind, listening and watching your co-workers. This was never more true for me a few years ago when the hospitalists wanted to be the primary for our patients in the ICU, the intensivists agreed and only came on the case if the patient was in the unit for more than 24 hours. We have since changed back and the intensivists manage the care of the patients, but that short time could have led to many poor outcomes if the nurses in the unit did not speak up and question orders.

Mandy

Professor,

Thank you for your reply. As nurses we use critical thinking skills everyday with all the nursing that we provide to our patients.  It just makes sense that as nurses we would want to look further into providing the patients and our career with the best possible way of doing things. We as nurses can see that many things we do as nurses may not be the best possible way of doing them and for the most part that is because we can see another way that is better.  That is where research and evidenced based research comes into play.  This is an opportunity for nurses to be able to research and look into other research that was done to see if the same question was asked before and if it was what did the research show.  Hopefully once we figure out the question and the answer we are able to implement the change as quickly and effectively as possible.

Hi Professor, Arianna, and Amanda,

Body language says it all, (CCN, 2018). It is very important that we change our patients’ and their families’ perception of us. Often times, in the critical care areas, we, especially females are seen as the “HELP.” For male nurses, they are always the “DOCTOR.” As a charge nurse, I am always encouraging the staff to acquire certification in their areas of practice, speak intelligently to the patients, families, peer, and physicians. People think you know what you are talking about when you sound like it, and when you are able to relay your message intelligently and effortlessly. Walk and dress with confidence.

TeamSTEPPS highlights how the patient care team uses knowledge, attitudes, and performance to provide safe, effective, high-quality healthcare services through leadership, situation, monitoring, mutual support, and communication, (Hood, 2013, p. 104).

Reference

Chamberlain University College of Nursing (CCN). (2018). NR 451 Week 1: Lesson – Establishing Differences in Research, Evidenced-Based Practice, and Quality Improvement Projects. Retrieved from http://frameste.next.ecollege.com

Hood, L. (2013). Leddy & Pepper’s Conceptual Bases of Professional Nursing (8th ed.). [Bookshelf Online]. Retrieved from https://online.vitalsource.com/#/books/9781469847122/

Professor,

Indeed nurses are the last line of defense for our patients. Blindly implementing orders without critical thinking skills can have devastating outcomes. I can think of two distinct examples. One where a nurse did not use her knowledge to protect her patient and one where a disaster was averted. Early in my nursing career we were still utilizing written orders. I remember getting report from a night nurse regarding a patient who “couldn’t keep his blood sugar up”. My ears perked up as I listed to a report I will never forget. I was told by this specific nurse that an order for HS insulin coverage was 100 units of Regular!!! The nurse proceeds to state she “thought that might be too much but figured that is what the doctor wanted!! Make a long story short, the doctor intended to write 10.0 units. The patient survived but was in need of supplemental dextrose drip and frequent labs. I will never forget this. The next example was not too long ago. I had a patient who had been status post arrest due to sustained vtach. The intensivist rounding the next day saw the patients potassium was slightly high but still within the parameters of “normal”. He in turn ordered Kaexylate to lower the K. This would have been appropriate treatment for a high K. However, I knew that with this patient being susceptible to vtach, cardiologists usually want to keep the patients K on the lower side. I had a conversation with the intensivist after receiving the order and he was very appreciative. Again, as our patients advocates, we must learn how to apply our knowledge for the betterment of our patients.

Jackie

The modern nursing practice puts nurses in leadership roles where they have to lead inter-professional teams to improve delivery care and systems; hence pay attention to the new set of competencies relevant to transforming meaningful health outcomes and performance. The evidence-based practice focuses on an effective health outcome. Nurse scientists have developed various evidence-based interventions to strengthen their evidence-based decision-making. The ACE Star Model of Knowledge Transformation is an important model which has helped nurses in translating evidence into practice (Stevens, 2013). Through this model, clinicians can utilize the nature of knowledge to make a clinical decision, especially at the point-of-care. Since the EBP model focuses on core competencies, the professionals get the opportunity to offer patient-centered care by identifying, respecting, and caring about patient’s preferences, needs, values, and differences (ANA, 2015). Patient-centered care competency makes it possible for the nursing profession to relieve suffering and pains and share decision-making processes with other professionals.

Hello Lucia,

Great post for this week, I as well chose the ACE model for my post, as I feel it relates more to nurses and what we do in our everyday jobs. I feel that is almost always up to us to catch the doctor’s and everyone else’s mistakes when it comes to patient care, as we are the most involved in our patient’s care, and the ACE model is easy to implement and follow in any clinical setting.

Great information on the ACE Star model. It is beneficial to the nurse that they can integrate EBP into actual nursing practice. It is helpful to see the EBP in your actual nursing practice. To see the interventions helping patient outcomes through direct patient care. When you can integrate the family and patient preferences with EBP it enhances the effectiveness and the patient outcome.

Hello Lucia,

I enjoyed reading your post. The ACE Star Model of Knowledge Transformation is one nursing model that closely resembles the nursing process.  This model incorporates both old and new concepts to provide a framework in which EBP may be organized. The nursing process along with nursing models provides nurses with Standards of Practice while addressing other practice issues or concerns. Nurses must advocate for the patients, and nurses must report any suspicions that they think might harm the patients negatively.

Edlyne

Great posts Everyone,

The profession of nursing has evolved since the days of Florence Nightingale to a level that is separate and unique from other professions. As a profession we provide holistic care that is based on evidence, and is patient centered. The role of the nurse and the profession of nursing is changing rapidly as we are better educated and better equipped to provide quality competent care. It is through research that we have been able to identify best practices that improve outcomes. We must integrate EBP into our practice to improve the quality of healthcare delivery.

Professor and Classmates,

Hi Everyone and great posts so far regarding the importance of EBP in nursing. I believe all of us as nurses should take a step forward by using research as part of our care. Research will help us acquire new knowledge on certain skills, learn information that will help us become a better advocate for our patients, and most importantly, learn new ways to deliver compassionate care based on the patient’s culture.

Scott

Wendi, I think it’s awesome y’all can plan around the family and have them on speaker phone if needed. That’s great!! I’ve not really thought how beneficial MDRs would be on a maternity floor but I’m sure they have lots of questions being a new mom and concerns for the babies —- so I’m sure it works out well.

Great post Jennifer,

I agree the nurse must listen to the patient and family and be receptive to feedback.  A patient advocate is one of the nurse’s first responsibilities, even if that choice is not one he/she would make in that same situation.  Education should be provided to the patient to be sure they have all of the information in regards to the situation.  It is ultimately the patient’s decision for their healthcare elections.  Once the decision has been made by the patient/family the healthcare providers should work around that decision to make the best out of the circumstances.

Hello Jennifer,

Gina, you made me laugh out loud!!! I also dreaded doing the rounds but they became such a great start to my day. I enjoy meeting with the patients and addressing their concerns with the Dr so I’m not putting out multiple calls. I can plan my day around the MDR and it helps me establish a trusting relationship with the patients as it shows I’m interested in their care and their concerns.

Inter-disciplinary rounding and patient education are important practices of effective patient centered care.

Scott

Jennifer,

Thank you for bringing to the discussion a very pertinent part of planning, incorporating inter disciplines and families into patient care through interdisciplinary rounding. My current unit (CICU) utilizes rounding daily at 1000. We incorporate the patient (if possible) and families. There they are given the opportunity to speak with the team as a whole. The intensivist, pharmacist, social worker, charge nurse, AOD, nutritionist, PT, RT are all involved. This allows any question on any topic about the patient to be addressed right then and there. It also allows me as a nurse to address any issues as well. Something magical happens when multiple disciplines put their heads together and formulate a plan for the betterment of the patient.

Hi Professor and Class,

Hi Class,

Kristine,your post point out the benefit of collaboration. Using EBP is a tool that gives nurses that extra knowledge or confidence. Patients on the other hand, want to have that active roles in their cares. Therefore, when using EBP in collaboration with the patients, their families, and other health care professional involve in the care, this will for sure improve the quality of care/outcomes.

Great post,

Gina

Kristine, Jackie and Class,

I believe all of us as nurses should take a step forward by using research as part of our care. Research will help as acquire new knowledge on certain skills, will learn information that will help us become a better advocate for our patients, and most importantly, will learn new ways to deliver compassionate care based on the patient’s culture

Scott

I am proud of the advances I’ve made in my knowledge but I like many others am never satisfied with stopping just there. This field of study is constantly growing and expanding and so should our knowledge. We gain a great deal of this knowledge from our daily practice but we must also commit to researching and actively seeking out knowledge from journals and studies conducted by our peers. I can’t imagine that people in this field of study could remain comfortable long with their current knowledge base with everyone else around them including the practice itself is growing and leaving them behind. As mentioned by Gwendolyn, we are the patient advocates. How can one advocate on their patients behalf effectively without being fully informed about the care being provided and the options for care available to that patient. It is our responsibility to continue to learn and advance so that we can provide them highest quality of care within our power.

The strength of the research certainly makes a difference whether it ready to be implemented into EBP, however all research is encouraged regardless of strength because it may just be the start to a major breakthrough within our practice.

I have worked with nurses that are comfortable with their current knowledge and don’t make an effort to learn new things. I believe nurses should  understand the implications of professional accountability. It is a responsibility that nurses sign up for, the need for the wide variety of knowledge required in order to provide excellent care. There is the added challenge of the need for continuous professional development as nursing knowledge is constantly evolving.

Lucy

Nicole,

The strength of the evidence also makes it worthy to even be considered for translation into practice! I think the only exception might be a pilot study. The pilot study may not show the strongest evidence, but may still be worthy of further study or research. Depending on more extensive research, it may then be applicable to EBP. The responsibility of the nurse is to educate and provide the best options and then listen to the patient/families for their beliefs and preferences. Being a patient advocate, we as nurses, play a critical role in the education of patients/families steering them to find an option which is safe, includes the best outcome and suits them.

Wendi Keller

Professor and class,

“To affect better patient outcomes, new knowledge must be transformed into clinically useful forms, effectively implemented across the entire care team within a systems context, and measured in terms of meaningful impact on performance and health outcomes” (Stevens, K., 2013). This process is what creates evidenced based practice. Peer reviewed and evidence based practice strengthens the research question and indicates patient outcomes, which is then put into routine practice. According to Chamberlain College of Nursing (2018) there are several evidence based nursing models. These include: The Stetler Model, Advancing Research and Clinical Practice Through Close Collaboration (ARCC) model, EBP Iowa Model, and Promoting Action on Research Implementation in Health Services Framework (PARIHS) model. It is important to integrate evidence based practice with patient and family practices. When you are able to integrate evidence based practice with the patient and family preferences the patient outcome will improve. If the two do not line up, it is the nurses responsibility to educate the patient and family. The nurse should provide literature and reinforce evidence based practice teaching and integrate it into the patient and family’s preference the enhance the patient outcome.

Chamberlain College of Nursing. (2018). NR-451 Week 1: Establishing Differences in Research, Evidenced- Based Practice, and Quality Improvement Projects (Online Lesson). Downers Grove, IL: DeVry Education Group.

Stevens, K., (May 31, 2013) “The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4. Retrieved from: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html (Links to an external site.)

Hi Edlyne,

You stated in your post that “At the facility where I work the doctors, medical students, and nurses work together to educate the patient in their disease process.” and I think that is not only amazing but really important. Coming from the facility I work at, we also try to educate our patients together but I feel at times we fall short due to us educating our patients at times based on opinion and not EBP or fact. Working in mother/baby I see a lot of patients who get information from 4 different sources including their doctor and it isn’t always the same or correct information being taught. I think that as a team, doctors and nurses should be on the same page when it comes to teaching our patients and making sure they are hearing the same correct information throughout their stay by all staff members. I never want my patient to feel like we are incompetent and don’t really know what we are talking about because they are given two totally different answers to a question she asked both the doctor and the nurse. So I definitely believe Evidence-based practice is important when it comes to doing our job and not only educating our patients but providing awesome patient family care.

All the best to you,

EBP isn’t something that’s just ‘nice to do’ anymore. It is something that we have got to do to improve quality and safety in health care and to improve patient outcomes.

Scott

Professor Scott,

The children’s hospital that I work in is on the journey to magnet status and already I see the EBP growing!

Wendi Keller

HI Professor and class,

The organization that I previously worked for was a comprehensive cancer center and a Magnet hospital. The organization incorporated EBP and used EBP as an effective tool to continue to provide excellent patient care and outcome.

Thanks

kristine

Just realized only part of my answer copied over, here is the whole response:

Our lesson this week reveals and discusses 6 models of evidence based practice (EBP) currently in use. “The Johns Hopkins Nursing Evidence-Based Practice Model (JHNNEBP) uses three major steps and a team approach to determine the evidence-based question for inquiry and focuses on the translation of research into practice. The Stetler Model focuses on critical thinking and emphasizes evaluation of the evidence which may include data from the consensus of experts or quality improvement data. The ARCC model (Advancing Research and Clinical Practice through Close Collaboration) emphasizes evidence-based implementation at a system level through the use of an EBP mentor. The next model mentioned is the EBP Iowa Model which focuses on the organizational level. The model has defined decision points and feedback loops represented as an algorithm and addresses translation and implementation of EBP. Finally, the Promoting Action on Research Implementation in Health Services Framework (PARIHS) model has applicability for engaging stakeholders through the use of evidence, context, and facilitation. The ACE Star Model of Knowledge Transformation is defined as an interdisciplinary approach for translating research into practice and attaining quality improvement. The model is typically illustrated as a five-point star that represent discovery of new knowledge; summary of the evidence; translation of the evidence; integrating change into practice; and evaluation of the change. (CCN, 2018)

According to our lesson, evidence based practice is the use of “current best conclusions or evidence produced by current research efforts,” (CCN, 2018). Based on the strength of the evidence, the practice may be implemented into practice.  The American Speech-Languarge-Hearing Association defines EBP as “is the integration of: (a) clinical expertise/expert opinion, (b) external scientific evidence, and (c) client/patient/caregiver perspectives to provide high-quality services reflecting the interests, values, needs, and choices of the individuals we serve,” (EBP). I really liked this definition because it clearly states the primary principles of EBP and the integration of interdisciplinary collaboration, IOM’s goals, and scientific research. In order to provide quality care that is patient (and family) centered, that improved patient and employee safety, and improved patient outcomes. It also clearly lays the foundation for decision making when there may be conflict or ethical concerns. It is the nurse’s responsibility to determine, within her scope of practice, the best practice, that allows the patient access to the safest, highest quality care.

Center for Evidence-Based Practice. (2013). Retrieved from https://www.hopkinsmedicine.org/evidence-based-practice/ebp_2013_models_tools.html

Chamberlain College of Nursing. (2018). NR-451 Week 1: Establishing Differences in Research, Evidenced- Based Practice, and Quality Improvement Projects [Online Lesson]. Downers Grove, IL: DeVry Education Group.

Evidence-Based Practice (EBP). (n.d.). Retrieved from https://www.asha.org/Research/EBP/

Stevens, K. R. (2013). The impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 18(2), manuscript 4. doi:10.3912/OJIN.Vol18No02Man04. Retrieved from https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/1449497144?OpenUrlRefId=info:xri/sid:wcdiscovery&accountid=147674 (Links to an external site.) (Links to an external site.)

Hi Jill, I couldn’t agree with you more. Research is important when it comes to providing high-quality safe patient care. Things change so much in healthcare and practices that we used yesterday may not be the correct practice according to EBP tomorrow. As I like to call myself a newer nurse, I hear older nurses say that the way we used to do things 10 years ago or 20 years ago is totally different and that is so true. I have been a nurse for 5 years and when I initially started compared to now, things have changed. Even just from paper charting to computer charting. Research is being done daily and we are changing, technology is advancing and healthcare is evolving and that is great.

All the best to you,

Samara D.

Hello class and Professor Scott,

Thank you for your reply. I work for one of a major hospital in South Florida which is the Jackson Health System (JHS). This hospital is partnering with another great hospital which is the University of Miami. Both of them partner together to educate the upcoming nurses and doctors while operating as independent institutions. JHS is not only to provide the best care possible to both the community and the region it serves, but it also provides many services and programs to nurses/doctors to reach their highest potential or end goal. With that being said, for nurses to be engage in EBP, this is one of the goals of my organisation without question.

Thank you,

Gina K

Professor Scott,

At my organization, EBP is highly encouraged, changes are made to improve delivery of care and patient satisfaction. To keep up with the latest EBP nurses are encouraged to be members of a professional nursing organization and attend nursing conferences.  In addition, subject matter experts are invited to present at our bi-monthly in services. Furthermore, the medical equipment used at our facility is fitted with the latest technology.

We are also encouraged to bring up any issues to our nurse leaders and we have quarterly meetings with our director to talk about the current issue and ways to improve outcomes.  This practice has been very successful because our recent patient survey gave us a 96% patient satisfaction rating.

Hello everyone,

To Samara,

Patients, their families’ opinions and questions, and Google, a recipe for constant battle that we nurses face daily on the job. Luckily, using EBP informations is the best weapon any nurse can have to equip oneself  for that battle. You are so right with having the evidence to back up the information that you are given to them.It is the best feeling ever.

Good post,

Gina

In my unit, we recently transitioned to nurse-led rounding.  In all honesty, I see little difference in the multidisciplinary round dynamic only because before this change the care team always looked for the nurse for input and suggestions to the care being provided to the patient.    The only thing that change was the person giving the report on the patient.  I work in a pediatric CVICU and I believe it is paramount in having every member of the multidisciplinary team give their input on the patient’s condition pertaining to their area of expertise.  As long as every member of the team has an equal voice and a chance to be heard then it does not matter who is leading the rounds.

Professor and Class,

Worldwide, healthcare systems have a real strain to expand/improve efficacy and adequacy to control costs, and report how the systems work and to determine the quality of care provided. Nurses are an essential part of healthcare systems. They are coordinators of care, addressing the needs of their patients. Nursing models guide nurses and give them direction, and are the tools to be used to change nursing practice. “These models are specifically designed for nursing situations in many aspects of nursing and nursing settings” (CCN, 2018). Some models and frameworks of evidence-based practice (EBP) currently in use include:

1. The Johns Hopkins Nursing Evidence-Based Practice Model (JHNNEBP).
2. The Stetler Model.
3. Promoting Action on Research Implementation in Health Services Framework (PARIHS) model.
4. The ACE Star Model of Knowledge Transformation (CCN, 2018).

Nurses are able to use research to deliver evidence-based care, promoting quality health outcomes for their patients, families, communities and health care systems. This week’s lesson states , “The capability to evaluate and create research, incorporate EBP, quality improvement (QI) methods, and informatics are all critically significant for patient safety and enhanced patient outcomes”, (CCN, 2018). Therefore, Individualizing patient care as we gain an understanding of patient/family perceptions will help us (the nurse) to provide care in a holistic way while deciding if the utilized EBP is suitable for the patient. If EBP and the patient/ family preferences do not match, the nurse’s responsibility is to educate the patient/family and explore the best treatment options available that closely resembles the patient’s belief to promote patient centered care. “Due to the need to produce evidence on patient-centered outcomes from the viewpoint of the patient, Congress in 2010, founded and heavily funded the newly-formed Patient-Centered Outcomes Research Institute (PCORI). PCORI’s mission is to help people make informed health care decisions, and improve health care delivery and outcomes, by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the larger health care community”, (Stevens, 2013).

References

Chamberlain University College of Nursing (CCN). (2018). NR 451 Week 1: Lesson – Establishing Differences in Research, Evidenced-Based Practice, and Quality Improvement Projects. Retrieved from http://frameste.next.ecollege.com

Curtis, K., Fry, M., Shaban, R. Z., Considine, J. (2017). Translating Research Findings to Clinical Nursing Practice. Journal of Clinical Nursing, 26(5-6), 862-872. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/jocn.13586/full (Links to an external site.)

Stevens, K. (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), Manuscript 4. doi:10.3912/OJIN.Vol18No02Man04. Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html (Links to an external site.)

Hi Jackie,

Great job on your post. Loved how organized your post was. You made do many great points and made it easier to understand. I agree that incorporating EBP and families is a great combination. The family helps us understand the patient more. Good job

Kierra

Guy,

You make a good point about making sure that we uphold our responsibility to the patient as advocate and to our position as educator. If there comes a time when the patient decides not to proceed with recommended care, it may present as an opportunity for an ethical committee consultation. As the nurse, we wear many hats and must make sure that we are doing our due diligence for each one. There is also evidence based practice when it comes to ethics and when it is ok to just allow the patient to disregard the EBP in relation to his care and it becomes our turn to follow the EBP in relation to an ethical decision. “The Identification, Exploration and Generation of Possible Solutions to the Problem and the Implications of Each” should be explored. “All possible solutions and alternatives to resolve the ethical dilemma are explored and evaluated,” (Ethical practice: NCLEX-RN).

Ethical practice: NCLEX-RN. (n.d.). Retrieved from https://www.registerednursing.org/nclex/ethical-practice/

I appreciate how you mentioned we must always advocate for our patients. Nurses hold the unique distinction of being the most trusted profession in the nation. That trust comes with the responsibility to ensure patients a voice in the delivery of their care.

Scott

Hi Class,

Nursing skills are strengthened because of evidence-based practices. Nurses should always be working to raise the standard and the bar thus delivering the highest quality of care to our patients. Through the nursing process, nurses are always problem solving and asking how, what, when, and why.  With this body of knowledge, the nurse are then putting a plan of action together to manage their patient care with best practice. Knowledge and evidence equals power to change!

Scott

Hello class,

Rebecca great post,

The consensus of the evidence by the patient and family, religious, socio-economic and ethical as well as legal factors that have to be considered. If it is a group of nurses dealing with one patient, they all have to agree with the evidence unanimously or at least a majority of them before it can be translated into practice.

The patient and family have the last consent to give before any treatment plan including an evidence-based one can be put to practice. Without the consent of either or both of these parties, then any treatment plan is unauthorized and illegal and can result into a lawsuit to the nurses as well as the whole hospital. It is therefore important to integrate evidence-based practice with the preferences of the family or those of the patient as long as they do not lead to harm being caused on the patient which can be avoided. When the family and patient are part of the EBP treatment, it means that they have understood the help it will accord the patient. When there is no integration, then the nurses have to find a way to offer treatment that will prolong the life or convince the family to accept the EBP.

Hi Everyone,

Nurses are leaders in patient care. We have significant influence, but often don’t see ourselves as leaders. Yet we have a direct influence on hospital acquired infections, falls, pressure ulcer development, pain management, quality improvement, and safety. We also influence length of stay, complications, mortality, patient satisfaction, and the resumption of the activities of daily living. By acting as leaders, nurses can influence not only the outcomes of their patients but also the outcomes of the organization!

Scott

Daniel great post,

If  EBP offered by the nurse and the family or patient practice to not match, the nurse has to seek another different EBP plan that will be acceptable and match family preference. The nurse will also seek advice from others that understand the preference of the family or patient and follow the best treatment plan (Schaffer, Sandau & Diedrick, 2013). The nurse cannot however give up on the patient until they find a uniform solution with the patient or family that will aid the patient’s recovery in both the short and long term.

References

Schaffer, M., Sandau, K. & Diedrick, L. (2013). Evidence-based practice models for         organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209.

Great post. I enjoyed reading your post because you made many great points. I agree that we must include the families in the care of our patients. Most family members are the care takers of their loved ones, so they know the patient best.

Kierra

Good evening Class and Professor,

One of the current models of EBP is the John Hopkins Nursing Evidence-Based Practice Model (JHNEBP). It emphasizes on individual use by bedside nurses to offer the best care decision for their bed-ridden patients. The other model is the Advancing Research and clinical Practice through Close Collaboration (ARCC). This model advocates for organizational use by all the nurses. It takes into consideration the organizational culture and focuses on cognitive behavioral theory when implementing EBP in the organization. This model can be used in all areas of the organization. Lastly is the Stetler Model which emphasizes on individual nurse but may also apply to group of nurses. It also emphasizes on using critical thinking and external research. In this model, there is also need for seeking consensus, bearing into mind opinion and the outcome before the EBP is implemented on a patient (Schaffer, Sandau & Diedrick, 2013).

EBP focuses on nurses seeking evidence from research, consultation as well as their experience before determining the best course of care for a patient. When the strength of the research, as well as evidence of the best course of treatment and care for a patient is high, then there is better translation into practice. This is however more theoretical as there are other factors that play into account before practice of the evidence no matter how strong it is.

The responsibility of the nurse at all times is towards the well-being of the patient, and this is the reason that they move into EBP, in order to provide the best care plan.

References:

Schaffer, M., Sandau, K. & Diedrick, L. (2013). Evidence-based practice models for         organizational change: overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209.

Hello Professor and Class,

The medical field is relentlessly changing and evolving. As such, it is critical for nurses always to update themselves on the current research on this line since it affects their services to patients. Evidence-Based Practice (EBP) makes use of the existing evidence, recommendations, or conclusions, produced by the current research studies to make informed decisions about the care for patients.

Nursing models and frameworks provide nurses with the direction to make changes to their practice and implement new and better strategies with the aim of improving service delivery. According to Nilsen (2015), there are five models and frameworks of EBP, including determinant frameworks, classic theories, evaluation frameworks, process models, and implementation theories. Other widely implemented EBP models in nursing practice include; Promoting Actions on Research Implication in Health Services Framework, EBP Iowa Model, and John Hopkins Nursing EBP model. Choosing the most viable nursing model and framework depends on a range of factors including the specific problem and preference.

The ability of a medical researcher to investigate and produce research, integrate EBP, create quality improvement approaches, and informatics are very critical to improve service delivery and to ensure patient safety (Chamberlain College of Nursing, 2017). Moreover, there is a very significant association between the strength of the research evidence and its value for nursing practice. Essentially, the stronger the research evidence, the higher the likelihood of being critical in practice.

Due to the fact the medical line takes a comprehensive approach, it is essential to integrate EBP model along with family and patient preferences, and the constituents of the decision-making process which include focusing on the population served. If the EBP model and the choices of the family and patients are not mutual, the nurse should educate the two parties with the aim of explaining the best treatment option that is available (American Nurses Association, 2015). Nonetheless, if the family and the patient maintain their position or thoughts, then the nurse is responsible for selecting the evidence-based option which closely resembles the beliefs or opinions of the patient.

References

American Nurses Association. (2015). Nursing: Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.

Chamberlain College of Nursing. (2017). Establishing Differences in Research, Evidenced-Based Practice, and Quality Improvement Projects [Online lecture]. Retrieved from nursingonline.chamberlain.edu

Nilsen, (2015). Making sense of implementation theories, models, and frameworks. Implementation Science. doi: 10.1186/s13012-015-0242-0

Thank You,

Christina Chirino