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Item type Presentation
Format Text-based Document
Title Overcoming Buzzwords and Variability Through a NurseEBP Mentor Program
Authors Bricker, Diedre
Downloaded 13-Jun-2018 21:12:24
Link to item http://hdl.handle.net/10755/622261
What Is Evidence-Based Practice (EBP):Overcoming Buzzwords and Variability Through a Nurse EBP Mentor ProgramPresented by:Kathleen Martinez MSN RN CPNPolicy and Procedure Oversight Manager
Diedre Bricker MSN RN CRRN CPHIMSInnovations & Outcomes Specialist
Donnya Mogensen, MS RN-BCProfessional Development Specialist
Children’s Hospital Colorado
Delivering pediatric health care since 1908
•Affiliated with University of Colorado School of Medicine and College of Nursing
17 Locations throughout Colorado•Serving a 7 state region
534 Inpatient Beds2,200 Registered Nurses
•90% Bachelors Degree or higher•47% Certified
300 APRNsAdmissions: 16,000Outpatient visits: 740,000
Children’s Hospital Colorado
Evidence-Based Practice (EBP) has become a buzzword in healthcare.
Children’s Hospital Colorado
EBP Improves
• Patient Outcomes
• Reduces Costs
• Standardizes Practice
Clinicians Don’t Use EBP Because
• Too Hard
• Lack Knowledge
• Lack Experience
Children’s Hospital Colorado
(Fink, Thompson, & Bonnes, 2005; Harrison, Grapham, van den Hoek, Dogherty, Carley, & Angus, 2013; Melnyk, Gallagher-Ford, Long, and Fineout-Overholt, 2014; Stevens, 2013).
(Dogherty, Harrison, Graham, Vandyk, & Keeping-Burke, 2013; Fink et al, 2005; Stevens, 2013).
No consistency
in formal education
No consistency in individual
leaders in practice
Wide variability in
the skills, tools, and resources
Clinicians enter practice with various backgrounds, knowledge, and educational experiences leading to wide variability on
how “EBP” is practiced at the bedside.
Children’s Hospital Colorado
(Fink et al, 2005)
Organization adopted EBP language into
nursing vision, mission, strategic goals
Created clear job expectations for
utilization of EBP at all levels of nursing
through clinical ladder
• Provide Resources To Facilitate EBP, Research And Quality
• Evidence-Based Professional Nursing Practice
• Support Innovation and The Advancement of Nursing Practice
• Clinical Ladder Based on QSEN Competencies
• Four Level Ladder – clear expectations for how to demonstrate EBP behavior at each level
Children’s Hospital Colorado
The BIG Picture QSEN Framework• Patient-Centered Care• Teamwork &
Collaboration• Evidence Based
Practice• Quality Improvement• Safety• Informatics
QSEN Frameworkin Practice
Preceptor Workshops
Job Descriptions
Competency Assessments
Clinical Ladder
Clinical Orientation
New Graduate
Nurse Residency
Children’s Hospital Colorado
Start of Our Journey: Evaluated the New Graduate Nurse Residency Program
Structure-Didactic
QI/ Audits/Research
Timelines/Process/Rubrics
Evaluations
Children’s Hospital Colorado
Children’s Hospital Colorado
Attended EBP Immersion
• 5-day immersion• Create PICOT question• Search the literature• Rapidly appraise literature• Synthesize using standard
tools• Present findings
ARCC Model for System-wide Implementation and Sustainability of EBP
(Melnyk Fineout-Overholt, Gallagher-Ford, Stillwell, 2011, p.58).Children’s Hospital Colorado
EBP Mentor Program Development
• EPB Project mentoring
• New Graduate Nurse Residency program evaluation
New Graduate Nurse Residency Program
• Literature search
• Staff development
Exploration
• Program evaluation
• House wide needs assessment
• Cost / Benefits
• Funding
Partnered with Leadership
Children’s Hospital Colorado
EBP Mentor Program Development
• Gap analysis
• Identified key mentors
• Hosted four, 1-week immersions (2015-2016)
• Modified residency program
EBP Training
• Enthusiasm for program
• Buy in from other disciplines
• Large interest in becoming mentors (2016)
Spread
• Hosting 1 more, 1-week immersion (2017)
• Continuing education
Sustain
Children’s Hospital Colorado
EBP project outline • Develop PICO questions
• Level the evidence
• Synthesis the evidence
• Design poster
• Disseminate
Monthly classroom instruction on steps of EBP
Mentored by trained EBP experts
Designed tool to assess nurse residents knowledge skills and attitudes related to EBP
EBP in the Nurse Residency Program
Children’s Hospital Colorado
Structure to Support Mentors
Clinical Inquiry Council
• Education for mentors
• Support and development for mentors
• Project approval process
• Mentor pathway
Tools
• Developed forms and templates to support process
• EBP website for easy access
Education
• CTEP week-long immersions
• Online Endnote, PubMed, Microsoft Products Videos (on demand)
• Journal Clubs to hone skills
• Mentor workshop
• EBP overview
• Monthly OSU-CTEP EBP webinars
Children’s Hospital Colorado
Organizational Assessment
• Response rate 17% (n=1013) – Baseline, 6 months, 12 months• 82% staff RNs; 5% CNS/Educator; 2% APN; 7% manager/administrator; 4%
other.
Do we have the process and structure to
support EBP?
• Organizational Culture & Readiness for System-Wide Integration of Evidence-based Practice Survey (OCRSIEBP)
Are our people ready for EBP?
• Evidence-based Practice Beliefs Scale
Are we demonstrating the behaviors of EBP?
• Evidence-based Practice Implementation Scale
Children’s Hospital Colorado
Analysis of Organizational Assessment
One variable demonstrated significant improvement (p=.003) in each timeframe
• Presence of EBP champions among staff nurses.
Five questions demonstrated significant improvement (p< .05) from baseline to 6 months and then decreased at 1 year:
• EBP is practiced in my organization.
• We are ready for EBP.
• EBP takes too much time.
• EBP is difficult.
• I know how to implement EBP.
Two questions demonstrated significant decline (p = .000) in scores at all timeframes
• Confidence about my ability to implement EBP.
• Believe that my care is evidence-based).
K. Oman, 2017
Eleven key questions (thought to represent training impact) were examined at baseline, 6 months, & 12 months using ANOVA
Outcomes
100 Formally Trained EBP
Mentors
13 EBP Mentors Have Been
Through Training >2x
+36 New Grad Residency EBP
Projects
12 Interdisciplinary CTEP Trained
Partners
OutcomesWhat a Difference a Year Makes!
23 Practice Changes
Implemented
10 Planned Practice Changes
9 New Nurse-led Research
Studies
Practice Changes Implemented
CHG Bathing In The NICU
Improved Shared Governance
Meeting Structure
Library Improved Literature Search Request Process
Alcohol Impregnated Caps
House Wide
Standardized Pressure Injury
Treatments
6th Floor Education Now Focused On
Specialties
Changing Organization
Thermometers To Temporal
Created Process For Storing “Internal
Evidence” For Policy Changes
Nurses Do Clinic Teaching For Patients With
Tonsillectomies
Consistent Debriefing For ED Staff After Medistat Alerts
Sensory And Vegetable Garden At Kidstreet For Medically Fragile
Children
Pressure Ulcer Bundle Change To Include
Elements For Caring For New Trachs
Practice Changes Implemented
NICU Education Changes From Didactic
To Interactive
Changed Vendors For Waterproof Casts In Ambulatory Clinic
Nurse Visits In Clinic For Depo Shot Administration
Peer Mentoring Of New Hire MHCs For
Retention
“Access Plan” Implemented For
Medically Complex Patients In Special Care
Clinic
Handoff Communication
Between Inpatient Care Manager And OPC At
Discharge
Improving CCRO Consent Process
Created Nurse Researcher
Competencies In CCRO
Changes To Appendicitis Imaging
Standards In ED Resulting In Decreased
CT Scans
Implemented Night Shift Rotations For
Nursing Students At CHCO
Nurse-led Research Studies
Nasal Bridle For Securement Of NG Tubes
Value Of Nurse Teaching In Clinic For Patients With
Tonsillectomy
Steroid Use In Cardiac Surgical Patients And
Effect Of SSI
Nursing Workarounds In Clinical Practice
Pediatric Deep Tissue Pressure Injury
Prevalence)
Analysis Of ST Segment Alarm Monitoring In The
Pediatric Population
Effectiveness Of Centralized Patient Education Center
How Does Concept Mapping Compared To
Care Planning Affect Critical Thinking/Clinical
Reasoning Ability
Development Of Pressure Ulcer Assessment Tool In The Neonatal Population
References
Dogherty, E. J., Harrison, M. B., Graham, I. D., Vandyk, A. D., & Keeping-Burke, L. (2013). Turning knowledge into action at the point-of-care: The collective experience of nurses facilitating the implementation of evidence-based practice. Worldviews Evid Based Nurs, 10(3), 129-139. doi: 10.1111/wvn.12009
Fink, R., Thompson, C. J., & Bonnes, D. (2005). Overcoming barriers and promoting the use of research in practice. J Nurs Adm, 35(3), 121-129.
Harrison, M. B., Graham, I. D., van den Hoek, J., Dogherty, E. J., Carley, M. E., & Angus, V. (2013). Guideline adaptation and implementation planning: A prospective observational study. Implement Sci, 8, 49. doi: 10.1186/1748-5908-8-49
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Stillwell, S. B. (2011). Sustaining evidence-based practice through organizational policies and an innovative model. AJN, 111(9), 57-60.
Melnyk, B. M., Fineout-Overholt, E., & Mays, M. Z. (2008). The evidence-based practice beliefs and implementation scales: psychometric properties of two new instruments. Worldviews Evid Based Nurs, 5(4), 208-216. doi: 10.1111/j.1741-6787.2008.00126.x
Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews Evid Based Nurs, 11(1), 5-15. doi: 10.1111/wvn.12021
Stevens, K. R. (2013). Impact of evidence-based practice in nursing and the next big ideas. Online Journal of Issues in Nursing, 18(2). Downloaded: http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based-Practice.html?css=print
Wallen, G. R., Mitchell, S. A., Melnyk, B., Fineout-Overholt, E., Miller-Davis, C., Yates, J., & Hastings, C. (2010). Implementing evidence-based practice: effectiveness of a structured multifaceted mentorship programme. J Adv Nurs, 66(12), 2761-2771. doi: 10.1111/j.1365-2648.2010.05442.x
Children’s Hospital Colorado
Contact Information
Diedre Bricker, MSN RN CRRN CPHIMS | Innovations & Outcomes [email protected]
Donnya Mogensen, MS RN-BC | Nurse Residency Manager | [email protected]
Kathleen Martinez, MSN RN CPN | Clinical Policy Oversight [email protected]
