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Implementing EBP Column Improving Patient Care Through Nursing Engagement in Evidence-Based Practice Elizabeth Crabtree, MPH • Emily Brennan, MLIS • Amanda Davis, MPH, RD • Andrea Coyle, MSN, MHA, RN, CMSRN This column shares the best evidence-based strategies and innovative ideas on how to facilitate the learning of EBP principles and processes by clinicians as well as nursing and interprofessional students. Guidelines for submission are available at INTRODUCTION AND BACKGROUND The Medical University of South Carolina (MUSC) is a large academic health science center, with a 700-bed medical cen- ter (MUSC Health), and six colleges that train approximately 2,600 healthcare professionals annually.

The MUSC Center for Evidence-Based Practice (EBP), housed jointly in the Li- brary and the Quality Management department of the MUSC Hospital, aims to promote scientific inquiry, EBP, and quality outcomes at MUSC. Through education, the development of evidence-based clinical decision support tools and outcomes research, the Center for EBP has begun to transform the cul- ture of MUSC into one that incorporates best evidence into clinical practice on both an individual and system level. One of the strategies implemented by the Center for EBP to promote cultural change is an educational course: the EBP Nurse Scholars course, where nurses are taught about the the- ory, practice, and dissemination of EBP.

DETAILED DESCRIPTION OF STRATEGY Nurses serve on the frontline of health care, and have a unique opportunity to improve patient care through EBP (Hockenberry, Walaen, Brown, & Barrera, 2008). The staff nurse is a critical link in bringing evidence-based changes into clinical practice. Best practice only occurs when staff continu- ally ask questions about treatment and care, have the resources and skills necessary to search for and appraise research ev- idence, implement the evidence in practice, and evaluate its effectiveness (Dawes et al., 2005; Hockenberry et al., 2008). MUSC’s experience in preparing practicing nurses to do EBP was limited. To address this, the Center for EBP, in part- nership with the Center for Professional Excellence, developed a 12-week, project-based course to prepare nurses to engage in EBP.

The Center for Professional Excellence collaborates with internal and external customers to create growth and devel- opment opportunities for registered nurses. Additionally, the center is responsible for Magnet application and designation. The EBP Nurse Scholars course provides nurses with a com- prehensive overview of EBP, prepares them to frame clinical questions, perform literature searches, analyze and evaluate evidence, and translate that knowledge into something clini- cally meaningful. Members of the Center for EBP staff and library faculty provided lectures and individual consultations on framing clinical questions, conducting comprehensive lit- erature searches, understanding statistics commonly reported in research articles, and appraising and summarizing evidence using the GRADE criteria.

As part of the course, nurses se- lected a specific hospital policy and applied their knowledge to evaluating the evidence base for it. They then updated the policy to ensure it reflected current evidence and best practice. RESULTS The EBP Nurse Scholars course resulted in successful com- pletion of 15 projects related to nursing care and practice, and led to significant practice improvements (Table 1). In addition, several nurses have presented their findings at regional and national conferences. Pre- and post-course surveys demonstrated that the course improved nurses’ confidence with EBP methods and skills re- lated to research tools, statistical concepts, and study designs.

Data collected included responses from students from two EBP Nurse Scholars courses: Spring 2013 and Spring 2014. Participant Demographics The majority of students who participated in the course were BSN-level nurses working with adult populations at MUSC. 172 Worldviews on Evidence-Based Nursing, 2016; 13:2, 172–175. C© 2016 Sigma Theta Tau International Implementing EBP Column Use of research Cochrane Database of Systemac Reviews CINAHL Naonal Guideline Clearinghouse PubMed UpToDate (1= Never, 2= Once per month, 3= Once per week, 4= Few mes per week, 5= Once per day, 6= Mulple mes per day ) Median (Pre) Median (Post) Figure 1. Use of research tools in practice.

Table 1. Examples of Completed EBP Nurse Scholars Course Projects Abdominal X-Ray forNG/OGTubePlacement ClosedArterial Line LabSamplingSystem forPCICUPatients DischargePlanning for Psychiatric Patients ImprovingCare of Elderly in theAcuteCareSetting InternationalNormalizedRatioCut-Off forHeart Catheterizations Lidocaine4% forNonemergent IVStarts Oral Care for Infants Peripheral Administration ofChemotherapyAgents Postoperative Education Postpyloric Feeding toReduceRisk of AspirationPneumonia PreoperativeBathing PreventingTurniquet-Related Injuries inPatientsUndergoingTKA Safety of “QuickStartâ€DepoProvera ThermoprotectiveWraps inVery LowBirthWeight Infants The majority of participants were ICU nurses, and students typically had 0–5 years of experience.

Survey Results Study data were collected and managed using Research Electronic Data Capture (REDCap) electronic data capture tools, hosted at MUSC. Due to the continuous nature of the variables assessed in the pre- and post-tests for the EBP Nurse Scholars course, we used pre- and post-test median scores and the Mann-Whitney U test to measure significant changes in confidence with EBP methods, use of research tools in clinical practice, and understanding of statistical concepts and study designs. A complete listing of the survey questions can be found in Appendix 1, available with the online version of this article. After the course, there were significant increases in nurses’ confidence in critically reviewing literature (p < .001), their belief that EBP was necessary in nursing practice (p = .052), and their interest in improving skills necessary to use EBP in practice (p = .002).

There were also significant increases in the use of EBP resources in clinical practice, including the Cochrane Database of Systematic Reviews (p < .001), CINAHL (p < .001), National Guideline Clearinghouse (p = .049), PubMed (p = .005), and UpToDate (p = .018), as well as in the understanding of statistical concepts and study design methods (p < .001). Pre- and post-test median scores representing the improvements in EBP resource utilization and understanding of research concepts are included in Figures 1 and 2. The success of the EBP Nurse Scholars course led to the development of a project-based course for interprofes- sional teams of pediatric clinicians, all of which included a nurse. These teams received EBP education and worked together during this Interprofessional EBP course to frame clinical questions, systematically search for, and critically ap- praise and synthesize a body of research evidence for a par- ticular disease topic.

Based on their review of the evidence, teams developed clinical practice recommendations for each of the clinical questions they framed. These recommenda- tions were used to develop admission and emergency depart- ment order sets which were integrated into MUSC’s electronic Worldviews on Evidence-Based Nursing, 2016; 13:2, 172–175. 173 C© 2016 Sigma Theta Tau International Improving Care through EBP = Do not understand, 2= Understand somewhat, 3= Understand completely) Median (Pre) Median (Post) Figure 2. Understanding of Research Concepts. medical record. Finally, participants who completed either the EBP Nurse Scholars course or the Interprofessional EBP course were invited to participate in an EBP Leadership Pro- gram.

This program focused on implementation of their EBP project, evaluation of results, outcomes, and dissemination of findings. Through these courses, the Center for EBP is transforming the institution’s culture into one that builds EBP capacity, and incorporates best evidence into clinical practice on both an individual and system level. DISSEMINATION The Center for EBP staff has supported nurses in translating their projects into scholarly work. The EBP Leadership Program, the follow-up to the EBP Nurse Scholars course, provided nurses with the skills to both implement and evaluate practice change projects, but it also provided nurses with tools and resources for developing abstracts for poster and podium presentations.

As a result of these efforts, numerous course participants have had their work accepted for presentation at regional and national conferences. The Center for EBP applied for and received a competitive, internally funded grant to support nurses in attending conferences where they present the results of their EBP projects. The grant covers the cost of printing a poster for nurses who have had abstracts accepted. Funding the printing cost of the posters further encouraged nurses to attend conferences, and present their work, and motivated departments and units to provide support for nursing engagement in EBP scholarly work. Supporting professional growth and development is a nursing strategic priority at MUSC.

To support and promote nursing clinicians, three EBP Nurse Scholar projects were highlighted in MUSC’s Magnet document. Additionally, videos of nurses engaging in the EBP process were produced and disseminated internally. The videos highlighted scholars performing a literature search, analyzing and evaluating evi- dence, and translating that knowledge in to changes in nursing practice. WVN LINKING EVIDENCE TO ACTION Organizational cultures can be transformed through provision of EBP education and mentored implementation of EBP knowledge and skills. A project-based EBP education program can re- sult in an increase in utilization of EBP resources, and in improvements in knowledge and attitudes related to EBP.

The implementation and dissemination of EBP projects creates opportunities for nurses to partici- pate in the development of scholarly products, and results in professional growth and development. Author information Elizabeth Crabtree, Director of Evidence-Based Practice, Qual- ity, Management, and Assistant Professor, Library & Infor- matics, Medical University of South Carolina, Charleston, SC; Emily Brennan, Informationist, Research Librarian, and Assistant Professor, Library & Informatics, Medical Univer- sity of South Carolina, Charleston, SC; Amanda Davis, 174 Worldviews on Evidence-Based Nursing, 2016; 13:2, 172–175. C© 2016 Sigma Theta Tau International Implementing EBP Column Clinical Evidence-Based Practice Analyst, Medical University of South Carolina, Charleston, SC; Andrea Coyle, Professional Excellence Coordinator, Clinical, Services Administration, Medical University of South Carolina, Charleston, SC Address correspondence to Elizabeth Crabtree, Library & Informatics, Medical University of South Carolina, 171 Ashley Avenue, Library, Suite 408, Charleston, SC 29425; [email protected] Accepted 15 August 2015 References Dawes, M., Summerskill, W., Glasziou, P., Cartabellotta, A., Mar- tin, J., Hopayian, K., & . . .

Osborne, J. (2005). Sicily statement on evidence-based practice. BMC Medical Education, 5, 1. Hockenberry, M., Walaen, M., Brown, T., & Barrera, P. (2008). Creating an evidence-based practice environment: One hospi- tal’s journey.

Journal of Trauma Nursing, 15(3), 136–142. doi 10.1111/wvn.12126 WVN 2016;13:172–175 Worldviews on Evidence-Based Nursing, 2016; 13:2, 172–175. 175 C© 2016 Sigma Theta Tau International its content may not be copied or emailed to multiple sites or posted to a listserv without the articles for individual use.

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Introduction

Evidence-Based Practice (EBP) emphasizes the importance of integrating clinical expertise, patient values, and the best research evidence into the decision-making process for patient care. This model has transformed nursing and healthcare by ensuring that clinical practices are based on the best available evidence. At the Medical University of South Carolina (MUSC), the Center for Evidence-Based Practice devised various strategies aimed at enhancing EBP understanding and implementation among nursing professionals. This essay discusses the program's detailed framework, outcomes, and implications for nursing engagement in EBP to improve patient care.

Nursing as a Frontline Force in Patient Care

Nurses are often the first healthcare professionals to interact with patients, making them crucial for implementing evidence-based interventions. Hockenberry et al. (2008) note that nurses play an essential role in patient care by continually questioning treatment practices and improving standards through evidence-based changes. The need for proficient engagement with EBP is highlighted by Dawes et al. (2005), who assert that effective patient care relies on nurses' ability to evaluate and implement research findings.

Implementation of EBP Strategies at MUSC

At MUSC, the Center for EBP was created to foster a culture that prioritizes scientific inquiry and improves patient outcomes through EBP. The cornerstone of this initiative is the EBP Nurse Scholars course, a comprehensive, 12-week project-based course designed to equip nurses with the skills and knowledge to engage in evidence-based practice.

Course Structure and Educator Involvement

The EBP Nurse Scholars course integrates lectures and practical consultations focused on framing clinical questions, conducting literature searches, understating statistics, and employing appraisal methods such as the GRADE criteria. The involvement of both clinical and library faculty enriches the educational experience, translating theoretical knowledge into clinical practice (Crabtree et al., 2016).

Project-Based Learning

One of the defining features of the EBP Nurse Scholars course is its emphasis on project-based learning. Nurses select a specific hospital policy to evaluate against current evidence. They not only review the literature but also formulate evidence-based recommendations to update practices. This hands-on approach nurtures a sense of ownership among the nurses and underscores the importance of translating evidence into clinical settings.

Outcomes and Impact of the EBP Nurse Scholars Course

The results of the EBP Nurse Scholars course indicate notable success in transforming nursing practice at MUSC. The 15 projects completed by course participants ranged from enhancing discharge planning for psychiatric patients to optimizing postoperative education. Each project contributed significantly to practice improvements and patient care standards (Crabtree et al., 2016).

Evaluation of Course Impact

Pre- and post-course surveys provided insights into the course’s effectiveness. Results indicated a significant enhancement in nursing confidence regarding EBP methods (p < .001) and increased awareness of the necessity for EBP in nursing practice (p = .052). Nurses reported improved utilization of resources like the Cochrane Database of Systematic Reviews and CINAHL for clinical decisions, confirming that the structured approach positively influenced their engagement with EBP.

Dissemination of Findings

The dedication to EBP was further validated as nurses from MUSC presented their EBP projects at various regional and national conferences. The Center for EBP facilitated this process by providing funding for poster presentations, thereby encouraging nurses to actively share their evidence-based findings. This dissemination process strengthens not only the individual nurse’s professional development but also contributes to the advancement of nursing as a whole (Crabtree et al., 2016).

Organizational Transformation through EBP

A cultural shift towards integrating EBP into everyday clinical practice is evident at MUSC. The engagement of nurses in EBP education encourages critical thinking and prompt application of research findings to improve patient outcomes. Additionally, the Center for EBP has advocated for nursing clinicians' professional growth and development as part of MUSC's Magnet strategy.

Implications for Nursing Practice

The emphasis on EBP fosters a culture of inquiry within nursing, encouraging ongoing education and adaptation to contemporary clinical challenges. Access to relevant resources, structured educational programs, and collaborative environments promotes a landscape that values evidence-driven decisions in nursing care.

Future Directions

To broaden the reach and efficacy of EBP initiatives, institutions like MUSC should consider scaling their programs further into interprofessional domains. The future of patient care hinges on collaborative practice, whereby a multi-disciplinary approach will bolster the effectiveness of EBP strategies.

Conclusion

The implementation of the EBP Nurse Scholars course at MUSC has cultivated an environment where nursing professionals are equipped and motivated to engage with evidence in their practice. As nursing remains a pivotal component of patient care, the integration of EBP through structured educational initiatives will continue to enhance care quality and patient outcomes. This evolution not only benefits nurses and their professional development but ultimately elevates the standard of healthcare delivered to the community.

References

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