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Has the EBP Culture Transformed Nursing?
Improving Practice,
Improving OutcomesAnnabelle R. Borromeo,
PhD, RN, CNS
WHAT
WHY
HOW
What is
known
What we
know
CHASM NO. 1
CHASM NO. 2
WHAT WE KNOW
WHAT WE DO
KNOWLEDGE TRANSFER
WHAT WE KNOW
What is
known
What we
know
CHASM NO. 1
A QUICK ( 5-SECOND) TOOL TO DETERMINE WHETHER SOMEONE HAS WHAT IT TAKES TO
BECOME A GOOD NURSE
Snap (or click) your fingers
Forefinger
E-Test
1. Close your eyes
2. Snap the fingers of your dominant hand 5 times
3. With your forefinger, quickly draw the letter E on your forehead
The 5-second E-Test (Galinsky & Schweitzer, 2015)
A B E to self
E to others
Patients experiencing hypotension and shock should be placed in Trendelenburg position
to improve blood flow to the heart and brain.
True or False?
REFERENCES
Bridges N, Jarquin-Valdivia AA. Use of the Trendelenburg position as the resuscitation position: to T or not to T. Am J Crit Care. 2005;14(5):364–368. http://ajcc.aacnjournals.org/content/14/5/364.full.
Johnson S, Henderson SO. Myth: the Trendelenburg position improves circulation in cases of shock. Can J Emerg Med. 2004;6(1):48–49.
Makic MB, VonRueden KT, Rauen CA, Chadwick J. Evidence-based practice habits: putting more sacred cows out to pasture. Crit Care Nurse. 2011;31(2):38–62.
INFORMATION OVERLOAD
CHASM NO. 2WHAT WE
KNOWWHAT WE
DO
KNOWLEDGE TRANSFER
innovation is a process, not an event
Rogers, 1962
There is clear evidence that nurses are at risk for making more errors with longer work shifts. They also have more needlestick and musculoskeletal injuries, drowsy driving, sleep deprivation, and fatigue.
The greatest barriers to changing this staffing model are staff nurses and nurse leaders. Staff nurses reportedly like, demand, and have become accustomed to the 12-hour model, currently the norm in many organizations. Staff nurses like the increased income potential and perceive they have more time off. Nurse leaders resist the major organizational culture revolution they perceive would be required for change. In addition, the 7 p.m. to 7 a.m. shift facilitates staffing the 3 p.m. to 11 p.m. shift, a slot reportedly most difficult to staff.
Gieger-Borwn & Trinkof, 2010
1. Organizational culture revolution2. Difficult when things are still
working
When should the concern for nurses' health and well-being be factored into staffing decisions?
70
How often do we do the
right thing?
How often do we do the “right” thing?
• EVIDENCE-INFORMED
Knowledge Transfer:
Have we made a measurable difference?
What is the STATE of EBP implementa-tion?
Despite dramatic advances in nursing and medical research,
many nurses continue to promote outdated nursing
practices that have been proven ineffective, unnecessary, and in
some cases, downright dangerous. Based on tradition
rather than science, these “sacred cows” are often revered by nurses and hard to dislodge
from practice.
Has the EBP Culture Transformed Nursing?
Improving Practice,
Improving Outcomes
FOR THE INDIVIDUAL
Systematic Literature Review
+ Systematic review
Surveillance
For Institutions
Evidence-Informed
Care PlansClinical
Pathways
For Professional Organizations + Schools
Clinical GuidelinesPOEMs
Sogyal Rinpoche, in his book The Tibetan Book of Living and Dying, organizes the experiences of the bardo of dharmata into four phases: 1. luminosity, 2. union, 3. wisdom, and 4. spontaneous presence.
The Four Phases of the Bardo
References
• Galinsky, A. & Schweitzer, M. Friend or Foe. New York: Crown Publishing.
• Henriksen, K., Battles, J.B., Marks, E.S., et al. (2005). Advances in patient safety: From research to implementation, Vol 2: Concepts and methodology. AHRQ. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK20521/figure/A3537/
• Miller, J., & Hayes, D.D., Carey, K.W. (2015). 20 questions: EBP or sacred cow? Nursing 2015, 46(8), 46-55. Retrieved from https://journals.lww.com/nursing/Fulltext/2015/08000/20_questions__Evidence_based_practice_or_sacred.13.aspx
• Rogers, E.M., Diffusion of innovations, 5th ed. New York: The Free Press. In Titler, M.G., & Everett, L.Q. Translating research into practice: considerations for critical care investigators. CritCare Nurs Clin North Am (2001) 13(4): 487-504. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2659/figure/ch7.f2/?report=objectonly
• Titler, M.G. (2008). The evidence for evidence-based practice implementation in Huges, R.G. (ed.) Patient Safety and Quality: An Evidence-Based Handbook for Healthcare Research and Quality. Chapter 7. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2659/
Geiger-Brown, J., & Trinkoff, A.M. (2010). Is it time to pull the plug on 12-hour shifts. Part 1. The evidence. JONA, 40(3), 100 – 102.