Running head: EBP PERSPECTIVE AND SUSTAINABILITY 1

Evidence-Based Practice Perspective and Sustainability

Alison R. Douglas

Jacksonville State University

NU 708 Evidence-Based Practice and Quality Improvement in Healthcare

November 22, 2018

Evidence-Based Practice Perspectives and Sustainability

Evidence-based practice (EBP) is the structural backbone of “why” medical professionals

make decisions or recommendations for their patients. To treat patients accordingly, nurses need

to know what EBP is “most current” and “best” to implement. Before EBP is applied, several

steps must occur: STEP 0 – a nurse needs to be curious and STEP 1 – ask a PICOT question.

STEP 2 – understand how and where to conduct a search for information regarding the problem,

STEP 3 – appraisal of literature searched, STEP 4 – using clinical expertise and patient

preferences make an informed decision and implement change, STEP 5 – evaluate the outcome

and lastly STEP 6 – disseminate and convey the outcome findings to others (Melnyk & Fineout-

Overholt, 2015).

The nurse’s perspective of patient goals in seeking medical attention involves a

combination of three simple concepts: heal them, don’t hurt them and be kind to them. These

concepts have been presented to nurses in more recent years, as patient satisfaction has become

the desire of end outcomes. All patients and medical professionals should expect a health care

system that is committed to preventing harm, improving patient care and performing safe

practices using evidence (Flynn Makic & Rauen, 2016). The future role of the Doctorate of

Nursing Practice (DNP) involves these concepts and is the driving force behind the writer's

development as an advanced clinician. The purpose of this paper will focus on STEP 6 of the

EBP process; it will discuss barriers in EBP implementation, provide a PICOT question example,

and make recommendations of informed ideas translating evidence into practice for nurses,

patients, and families contributing to the sustainability of EBP.

STEP 6 – Disseminate and convey the outcome findings to others

Sharing results and disseminating EBP into clinical practice may be the most challenging

part of the EBP process (Mohide & King, 2003). Objectives in integrating EBP into clinical

environments should include establishing formal implementation teams, disseminating evidence,

develop/utilize clinical tools, pilot testing, preservation of energy sources, set a reasonable

timeline and celebrate success. During the dissemination of outcome findings “education should

be planned to overcome knowledge/skill deficits, and skepticism; eliminating knowledge deficits

includes not only communicating how to change but also why a change will be beneficial (the

outcome) and the evidence to support the change” (Melnyk & Fineout-Overholt, 2015). Sharing

positive outcomes of interventions can increase motivation toward change and strengthen staff

beliefs of utilizing EBP inpatient care (Melnyk & Fineout-Overholt, 2015).

Discuss barriers to implementing EBP. Anticipation, assessment, and discussion of

barriers should occur before the implementation of EBP changes to aid in the success of

teaching/understanding by those learning. Tradition encompasses nursing skills, but with an

ever-changing environment and need to improve outcomes, change becomes a vital necessity.

Change in the medical field is constant and tedious; as one must acknowledge that current

practices may be inadequate or obsolete. The need to stay abreast of outdated techniques and

traditions should be a priority for all nurses (especially the DNP). However, it is more

comfortable to become complacent with theory/practice that has worked in the past.

Common barriers to EBP implementation include inadequate knowledge and skills of the

staff, weak beliefs about the value of EBP, poor attitudes toward EBP, lack of EBP mentors,

social and organizational influences, and economic restrictions (Melnyk & Fineout-Overholt,

2015). Also, bedside care nurses have little control over their workloads, preventing

involvement in non-direct care activities (such as learning about EBP or participating in

evidence-based process improvements). A continuing nursing shortage results in more overtime

working hours, along with limited access to research journals/resources. Most nurses’ lack

training in literature searching and critical appraisal techniques, and they prefer experiential

knowledge to empirical evidence. Also, lack of managerial support for the implementation of

EBP and the complexity of modern healthcare organizations make change difficult (Mohide &

King, 2003). Barriers can be organizationally specific and are not limited to those listed above.

Engaging unit champions and staff in assessing and eliminating barriers of poor attitudes and

perceptions can be useful when implementing EBP changes. The DNP role in prioritizing

clinical issues, evaluating infrastructure, and developing experts in the EBP process can also aid

in eliminating barriers (Melnyk & Fineout-Overholt, 2015).

Using informed ideas to translate evidence into practice contributing to the

sustainability of EBP. The goal of translating evidence using teaching strategies and tools is to

facilitate learning of new and improved findings into practice. A straightforward way to share

informed ideas is through poster presentations. The benefits of sharing ideas through posters are

the translation of evidence is relaxed, informal and takes place in social environments as opposed

to a more formal setting such as podium presentations. Poster presentations can provide

education quickly to busy staff in unit settings by social interaction, hands-on exposure and face-

to-face discussions (Durkin, 2011).

An example PICOT question that would be appropriate to teach using EBP by poster

presentation is: In adults with Central Venous Catheters (CVCs), what is the effect of using

antiseptic barrier caps compared with alcohol swabs to prevent Central Line-Associated

Bloodstream Infections (CLABSIs) during inpatient hospitalization? This question was

researched utilizing the seven steps above, and the evidence proved that continuous antiseptic
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barrier caps are an excellent way to prevent CLABSI compared to the prior techniques of manual

disinfection using alcohol swabs to “scrub the hub.” Findings also proved it was more cost

effective to implement the caps as CLABSIs are no longer reimbursed for hospital-acquired

infections (HAIs) when there is clear evidence to prove they can be prevented, resulting in

hospitals taking the initiative to improve antiseptic practices at the bedside.

Although this question is simple in concept, the benefits are great for organizations and

provide better outcomes for the patients. A poster presentation of the above PICOT question and

findings would be relatively easy to create. Photograph utilization, equipment visualization;

along with champion lead instruction followed by a hands-on demonstration from learners

verbalizing and showing proficiency in understanding how to use caps. The poster could be

placed somewhere visible in the unit, and frequent reminders from leaders/champions could be

provided to foster new habits. The CDC’s National Healthcare Safety Network Patient Safety

Component includes surveillance methods to identify and track CLABSI rates (which hospitals

perform frequently) meaning a change in infection rates could be easily measured after the caps

were implemented (CDC, 2016).

It is also essential to translate evidence for patients and families to allow for more

involved participation in care and to provide education for relevant topics. The University of

Pennsylvania Health System developed a marketing acronym to aid in staff encouragement to

teach the patient and families called “R.E.A.C.H to Teach.” The “R” is to: “relate to the patient

and family” and encourages nurses to understand their perspective. It also encourages the

relationship with the learner. The “E” stands for: “educate simply.” Patients and family

members all have different education levels, keeping concepts simple, concrete, and credible can

aid in layperson understanding. The “A”: “ask and answer questions.” Patients respond well to
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being prompted with open-ended questions and allow for more opportunity than just yes or no

responses. The “C” represents: “checking for understanding.” Current literature recommends

using teach-back techniques to verify understanding. Lastly, the “H” stands for: “help promote

health literacy.” This concept allows a person to acquire and utilize health information to make

informed decisions (Crane Cutilli, 2016).

An example of applying the PICOT question regarding CLABSI prevention for patients

and families using the “R.E.A.C.H to Teach” method: the nurse could relate to the patient/family

by explaining the importance and value of their wellness (if available, share a personal story),

understanding the worry about central line catheter placement and risk of infection. The nurse

can educate simply by explaining the use of hub/port caps to prevent bacteria growth in their

bloodstream, teach that a cap always needs to be placed on un-used access ports and to help

monitor or let the staff know if any ports are missing caps. Ask the patient/family, what

questions do they have regarding disinfecting caps or infection prevention? Answer any

questions they may have. Check for an understanding, state that "clarification of the explanation

is important" (did the nurse do a good job teaching?) then have the patient/family restate what

they understand and what they can do to help prevent the spread of infection and bacteria

growth. Lastly, help promote health literacy by implementing EBP education to achieve

outcomes. Being informed is essential as patients and families need to have the ability to

advocate for themselves, in doing so, information and knowledge become critical in their

decision-making.

In summary, the process of EBP is imperative in understanding the “how” and “why” we

do what we do as medical professionals. Once evidence is proven, the final and perhaps most

important step is sharing the information with others to contribute to the sustainability of EBP.
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Teaching strategies such the utilization of poster presentations and campaigns utilizing acronyms

like “R.E.A.C.H. to Teach” can not only foster positive learning and better outcomes, it is also

what is best for those under our care. Taking better care of our patients by preventing harm,

improving care and performing safe practices using proven evidence is what turns mediocrity

care into great care. The sustainability of EBP is imperative and requires that nurses continue to

strive for the best outcomes for their patients.

References

Centers for Disease Control and Prevention. (2016). Central Line-associated Bloodstream

Infection (CLABSI). Retrieved from https://www.cdc.gov/hai/bsi/bsi.html

Crane Cutilli, C. (2016). R.E.A.C.H. to Teach: Making patient and family education “Stick.”

Orthopedic Nursing, 35(4), 248-252. doi: 10.1097/NOR.0000000000000260

Durkin, G. (2011). Promoting professional development through poster presentations. Journal

For Nurses in Staff Development, 27(3), E1-E3. doi: 10.1097/NND.0b013e318217b437

Flynn Makic, M.B., & Rauen, C. (2016). Maintaining your momentum: Moving evidence into

practice. Critical Care Nurse, 36(2), 13-18. doi: http://dx.doi.org/10.4037/ccn2016568

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing &

healthcare: A guide to best practice (3rd ed.). Philadelphia, PA: Wolters Kluwer.

Mohide, E.A., King, B. (2003). Building a foundation for evidence-based practice: Experiences

in a tertiary hospital. Evidence-Based Nursing, 6(4), 100-103. doi:

http://dx.doi.org/10.1136/ebn.6.4.100