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Over the past decade, nurses have been part of a movement that reflects perhaps more change than any two decades combined. The recommendation that nurses lead interprofessional teams in improving delivery systems and care brings to the fore the necessity for new competencies, beyond evidence-based practice, that are requisite as nurses transform healthcare. This discussion highlights some of the responses and initiatives that those in the profession of nursing have taken to maximize the valuable contributions that nurses have made, can make, and will make, to deliver on the promise of EBP.
Evidence-based practice holds great promise for moving care to a high level of likelihood for producing the intended health outcome.
Definition of Quality HealthcareDegree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (IOM 1990; 2013, para 3). The phrases in this definition bring into focus three aspects of quality: services (interventions), targeted health outcomes, and consistency with current knowledge (research evidence).
The EBP movement began with the characterization of the problem—the unacceptable gap between what we know and what we do in the care of patients (IOM, 2001). Leaders in the field have defined EBP as “Integration of best research evidence with clinical expertise and patient values” (Sackett et al, 2000, p.
The entry of EBP onto the healthcare improvement scene constituted a major paradigm shift. The EBP process has been highly applied, going beyond any applied research efforts previously made in healthcare and nursing. A recent survey of the state of EBP in nurses indicated that, while nurses had positive attitudes toward EBP and wished to gain more knowledge and skills, they still faced significant barriers in employing it in practice. In spite of many significant advances, nurses still have more to do to achieve EBP across the board.
Early in the EBP movement, nurse scientists developed models to organize our thinking about EBP. The ACE Star Model of Knowledge Transformation (Stevens, 2004) was developed to offer a simple yet comprehensive approach to translate evidence into practice.
The ACE Star Model of Knowledge Transformation highlights barriers encountered when moving evidence into practice and designates solutions grounded in EBP.
Bibliographic Databases such as CINAHL-provide single research reports, in most cases, multiple reports. Cochrane Collaboration Database of Systematic Reviews-provides reports of rigorous systematic reviews on clinical topics. National Guidelines Clearinghouse-sponsored by AHRQ, provides online access to evidence-based clinical practice guidelines. AHRQ Health Care Innovations Exchange-sponsored by AHRQ, provides profiles of innovations, and tools for improving care processes, including adoption guidelines and information to contact the innovator. National Quality Measures Clearinghouse-sponsored by AHRQ, provides detailed information on quality measures and measure sets.
Following the influential Crossing the Quality Chasm report (IOM, 2001), experts emphasized that the preparation of health professionals was crucial to bridging the chasm (IOM, 2003).
Work in interdisciplinary teams – cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable. Employ evidence-based practice – integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible. Utilize informatics – communicate, manage knowledge, mitigate error, and support decision making using information technology.
From this core set, IOM urged each profession to develop details and strategies for integrating these new competencies into education. A measurement instrument was developed from these competencies, called the ACE EBP Readiness Inventory (ACE-ERI).
Another curricular initiative became known as Quality and Safety Education in Nursing Institute (QSEN) (QSEN Institute, 2013). Investigation into uptake of evidence-based practice is one of the fields that has deeply affected the paradigm shift and is woven into each of the other fields. When the public cry for improved care escalated, rapid movement of results into care was brought into sharper focus in healthcare research. Nurses are involved in each of the 60 CTSAs that were funded across the nation… Nurse scientists have been significant leaders in the CTSA program, conducting translational research across these two areas.
Likewise, some of the most recent calls for research from the Agency for Healthcare Research and Quality (AHRQ) are also focusing on PCOR. Two additional federal initiatives exemplify what may be called the next big ideas in EBP—each underscoring evidence-based quality improvement.
A call for increased emphasis on implementation of evidence-based practices brought forth a federal funding program. Recognizing that pockets of excellence in safety and effectiveness exist, there is concern that local cases of success in translating research into practice are often difficult to replicate or sustain over time.
The ISRN supports rigorous testing of improvement strategies to determine whether, how, and where an intervention for change is effective.
The primary goal of the network is to determine which improvement strategies work as we strive to assure effective and safe patient care.
The new NIH D&I grant resources and the ISRN collaboratory are “the next big ideas” in advancing EBP today. Those leading clinical practice have willing partners from the academy for discovering what works to improve health care. Those leading education have great advantages offered from a wide variety of educational resources for EBP. Those leading nursing science have access to new funding opportunities to develop innovative programs of research in evidence-based quality improvement, implementation of EBP, and the science of improvement.
The challenges for moving EBP forward spring from two sources: nurses becoming powerful leaders in interprofessional groups and nurses becoming powerful influencers of change. Persistence in educating the future workforce, and retooling the current workforce, with awareness, skills, and power to improve the systems of care. The nursing profession remains central to the interdisciplinary and discipline-specific changes necessary to achieve care that is effective, safe, and efficient.
Portions of this work were supported by the National Institutes of Health, National Institute of Nursing Research NIH (1RC2 NR011946-01, PI K. On September 3, 2013, the Acknowledgment was modified from the original publication date of May 31, 2013. The Society for Human Resource Management (SHRM) Annual Conference is the best — and biggest — HR Conference in the world. You must have JavaScript enabled in your browser to utilize the functionality of this website. Please consider downloading the latest version of Internet Explorer to experience this site as intended. Candidates for doctoral degrees arrive for their ceremony in Kodak Hall at Eastman Theatre on May 14. As candidates receive their degrees, they are also presented with their doctoral hoods, a traditional symbol of the degree.
Liu Liu is presented with her doctoral hood after receiving her DMA in performance and literature from the Eastman School. Tom Boehly, a senior scientist at the Laboratory for Laser Energetics with PhD recipients Maria Barrios Garcia in physics and Dayne Fratanduono in mechanical engineering.
Hannah Shoemaker, who received her PhD in philosophy, poses for photos with her family in the Miller Center courtyard.
At the October 6 inauguration of the MacDonald Center for Obesity Prevention and Education (COPE) at Villanova University College of Nursing are Marcia Costello, PhD, RD, LDN, assistant professor and Chair of the COPE Advisory Committee; M.
In response to Americaa€™s health crisis of obesity, the College of Nursing at Villanova University has established the MacDonald Center for Obesity Prevention and Education (COPE) to foster the development of healthy lifestyles and behaviors among Americans through the education of health professionals and agencies, community groups and the public. With funding by the Take Shape for Life and MacDonald Family foundations, the MacDonald Center for Obesity Prevention and Education includes national experts on obesity advising on the latest developments in combating this epidemic. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
A collaborative effort in Texas teaches student nurses about LTCClick To View ImageFor too long, the stigma of LTC facilities has negatively impacted the delivery of healthcare for the nation’s elderly population. In a recent literature review, Koh2 concluded that negative student clinical experiences in long-term care may be related to students’ perceptions of caring for the elderly and a lack of pre-placement orientation to the practice environment.


Today, empowered by the work of the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine,1 nurses are realizing their role in this vision. Understanding barriers to effective communication is an essential aspect of safe patient care.
Physicians in the study reported that nurses needed to be brief and prepared with relevant clinical information when communicating with them. In this issue: The 2016 Leaders of Tomorrow Awards, managing disruptive visitors, grannycam policies and more. A number of selected influences of evidence-based practice trends on nursing and nursing care quality are explored as well as thoughts about the “next big ideas” for moving nursing and healthcare forward. It expresses an underlying belief that research produces the most reliable knowledge about the likelihood that a given strategy will change a patient’s current health status into desired outcomes. In the report, Crossing the Quality Chasm (IOM, 2001), IOM experts issued the statement that still drives today’s quality improvement initiatives: “Between the health care we have and the care we could have lies not just a gap but a chasm” (IOM, 2001, p. The intended effect of EBP is to standardize healthcare practices to science and best evidence and to reduce illogical variation in care, which is known to produce unpredictable health outcomes. This characteristic of EBP brought with it other shifts in the research-to-practice effort, including new evidence forms (systematic reviews), new roles (knowledge brokers and transformers), new teams (interprofessional, frontline, mid- and upper-management), new practice cultures (just culture, healthcare learning organizations), and new fields of science to build the “evidence on evidence-based practice” (Shojania & Grimshaw, 2005).
For EBP to be successfully adopted and sustained, nurses and other healthcare professionals recognized that it must be adopted by individual care providers, microsystem and system leaders, as well as policy makers.
A recent survey of the state of EBP in nurses indicated that, while nurses had positive attitudes toward EBP and wished to gain more knowledge and skills, they still faced significant barriers in employing it in practice (Melnyk, Fineout-Overholt, Gallagher-Ford, & Kaplan, 2012). As explained in the ACE Star Model, one approach to understanding the use of EBP in nursing is to consider the nature of knowledge and knowledge transformation necessary for utility and relevance in clinical decision making.
The model explains how various stages of knowledge transformation reduce the volume of scientific literature and provide forms of knowledge that can be directly incorporated in care and decision making. The Health Professions Education report (IOM, 2003) declared that current educational programs do not adequately prepare nurses, physicians, pharmacists or other health professionals to provide the highest quality and safest health care possible. With a focus on employing evidence-based practice, nurses established national consensus on competencies for EBP in nursing in 2004 and extended these in 2009 (Stevens, 2009). To stimulate curricular reform and faculty development, the IOM suggested that oversight processes (such as accreditation) be used to encourage adoption of the five core competencies.
Through multiple phases, this project developed a website that serves as a central repository of information on core QSEN competencies, knowledge, skill, attitudes, teaching strategies, and faculty development resources designed to prepare nurses to engage in quality and safety.
While the materials presented were in existence in other professional literature, the book added great value by synthesizing what was known into one publication.
Never before in healthcare history has the focus and formalization of moving evidence-into-practice been as sharp as is seen in today’s research on healthcare transformation efforts.
Investigation into EBP uptake is equivalent to investigating Star Point 4 (integration of EBP into practice). The National Institutes of Health (NIH), including the National Institute for Nursing Research (NINR), developed the Clinical Translational Science Award (CTSA) program to speed research-to-practice by redesigning the way healthcare research is conducted (Zerhouni, 2005). Nurses are involved in each of the 60 CTSAs that were funded across the nation, contributing from small roles and large roles, ranging from advisor and collaborator to principal investigator.
As evidence mounted on standard medical metrics (mortality and morbidity), it was noted that metrics and outcomes of particular interest to patients and families (such as quality of life) were understudied.
These calls encourage early and meaningful engagement of patients and other stakeholders in stating the research question, conducting the study, and interpreting results (AHRQ, 2013).
The initiatives call for better use of the knowledge that may be gained from quality improvement efforts. In January of 2013, the NIH initiative in dissemination and implementation was expanded across 14 institutes, including NINR. In many instances, studies about single innovations on Star Point 4 were often not rigorous or broad enough to produce credible and generalizable knowledge (Berwick, 2008). Factors that make a change improvement work in one setting versus another are largely unknown. Through this national research collaborative, rigorous studies are designed and conducted through investigative teams. These will provide the scientific foundation for the rapidly expanding efforts to make healthcare better.
The rich resources offer students a chance to meaningfully connect their emerging competencies with clinical needs for best practices in clinical and microsystem changes. Readiness of the clinical setting for academic-practice research partnerships brings with it advantageous access to clinical populations and settings and an eagerness for utilization of the research results. New in our vernacular and skill set are systems thinking, microsystems change, high reliability organizations, team-based care, transparency, innovation, translational and implementation science, and, yes, still evidence-based practice. Stevens is STTI Episteme Laureate, Professor and Director of the Academic Center for Evidence-Based Practice (ACE) and Improvement Science Research Network (ISRN) in the University of Texas Health Science Center School of Nursing San Antonio. Through the united expertise of nurses, registered dietitians and other health professionals, the Center will mobilize strategic actions to address the obesity epidemic and serve as a model for the promotion of healthy weight management, obesity prevention and intervention through education. In a recent study,6 telephone communication was identified as occurring more often in long-term care than in any other clinical setting. As identified by the researchers, a combination of nurse and physician behaviors contributes to ineffective communication. Nurses thrive in this environment that provides hope and empowerment of the elders and staff. Hartford Foundation's Centers of Geriatric Nursing Excellence National Nursing Home Collaborative creates opportunities for geriatric nurses to change the structures and processes of elder care in LTC facilities. The chasm between what we know to be effective healthcare and what was practiced was to be crossed by using evidence to inform best practices. Alignment of services with current professional knowledge (evidence) is a key goal in quality. Development of evidence-based practice is fueled by the increasing public and professional demand for accountability in safety and quality improvement in health care.
Therefore, EBP unifies research evidence with clinical expertise and encourages individualization of care through inclusion of patient preferences. Federal, state, local, and other regulatory and recognition actions are necessary for EBP adoption. Rather than having clinicians submersed in the volume of research reports, a more efficient approach is for the clinician to access a summary of all that is known on the topic. The ACE Star Model emphasizes crucial steps to convert one form of knowledge to the next and incorporate best research evidence with clinical expertise and patient preferences thereby achieving EBP. Important new knowledge resources have been developed and advanced owing to the EBP movement. The conclusion was that education for all health professions were in need of “a major overhaul” to prepare health professions with new skills to assume new roles (IOM, 2003).
The ACE Star Model served as a framework for identifying specific skills requisite to employing EBP in a clinical role. Initiatives that followed included the new program standards established by the American Association of Colleges of Nursing, crossing undergraduate, masters, and doctoral levels of education (AACN, 2013). Several notable federal grant programs have evolved to foster research that produces the evidential foundation for effective strategies in employing EBP. The term,translational science, was coined, and the definition was provided by NIH (2010): “Translational research includes two areas of translation. As part of the CTSAs, nurse scientists conduct basic research and applied research, adding significantly to the interprofessional perspectives of the science. In 2010, attention was drawn to the need to produce evidence on patient-centered outcomes from the perspective of the patient.
This new direction in healthcare research will produce evidence that is co-investigated by patients and families in partnership with health scientists, increasing relevance so that EBP reflects the patient’s viewpoint. Both initiatives emanate from the NIH and both focus on generating evidence needed to make systems improvements and transform healthcare.


In this call for research proposals, implementation is defined as “the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings” (NIH, 2013, Section I, para 11).
As a new field, improvement science focuses on generating evidence about employing evidence-based practice, providing research evidence to guide management decisions in evidence-based quality improvement. To fill this gap, the Improvement Science Research Network (ISRN) was developed (Stevens, 2010).
Foundational to the network is the virtual collaboratory, fashioned to conduct multi-site studies and designed around interprofessional academic-practice partnerships in research. While there are benefits to both as the evidence is gathered and applied, the true benefit goes to the patient. As they emerge from formal education, students will see great enthusiasm for employing EBP in today’s clinical environments.
She holds the UT System Chancellor’s Health Fellowship in interprofessional health delivery science.
The science of improvement. Journal of the American Medical Association, 299(10), 1182-1184. Dissemination and implementation research funded by the US National Institutes of Health, 2005–2012. Nursing Research and Practice, Article ID 909606, 15 pages. MacDonald, a€™71 Villanova University, A&S, executive chairman of the Board of Medifast, Inc.
These findings suggest that the organizational structure and culture play a significant role in supporting these skills in LTC nursing staff. For this reason, it is important to understand nurses’ perceptions of nurse–physician telephone communication that compromise care delivery and to identify strategies for improvement.
The definition also calls into play the aim of reducing illogical variation in care by standardizing all care to scientific best evidence. While this early definition of EBP has been paraphrased and sometimes distorted, the original version remains most useful and is easily applied in nursing, successfully aligning nursing with the broader field of EBP. This shift was apparent in the way nurses began to think about research results, the way nurses framed the context for improvement, and the way nurses employed change to transform healthcare. For example, through the Magnet Recognition Program® the profession of nursing has been a leader in catalyzing adoption of EBP and using it as a marker of excellence. The evidence-based program, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) (AHRQ, 2008) carries with it proven effectiveness of reducing patient safety issues and the program is available with highly-developed training and learning materials. Likewise, rather than requiring frontline providers to master the technical expertise needed in scientific critique, their point-of-care decisions would be better supported by evidence-based recommendations in the form of clinical practice guidelines. While resources were available for Point 1, only recently have resources been developed for the knowledge forms on Point 2, 3, 4, and 5 of the Model. This overhaul would require changing way that health professionals are educated, in both academic and practice settings.
Through multiple iterations, an expert panel generated, validated, and endorsed competency statements to guide education programs at the basic (associate and undergraduate), intermediate (masters), and doctoral (advanced) levels in nursing.
The ACE Star Model, competencies, and ERI have been adopted into practice settings as nurses strategize to employ EBP. The AACN standards underscored the necessity for nurses to focus on the systems of care as well on the evidence for clinical decisions. These emerging fields include translational and improvement science, implementation research, and health delivery systems science.
Among the new research initiatives are the Clinical Translational Science Awards and the Patient-Centered Outcomes grants.
One [“T1”] is the process of applying discoveries generated during research in the laboratory, and in preclinical studies, to the development of trials and studies in humans. In relation to EBP, nurses are valued contributors to the “T2” end of the continuum of translational science, applying skills in mixed methods and systems settings. Congress founded and heavily funded the newly-formed Patient-Centered Outcomes Research Institute (PCORI) with the following mission: “The Patient-Centered Outcomes Research Institute (PCORI) helps people make informed health care decisions, and improves health care delivery and outcomes, by producing and promoting high integrity, evidence-based information that comes from research guided by patients, caregivers and the broader health care community” (PCORI, 2013, para. This research initiative will add to our understanding of how to create, evaluate, report, dissemination, and integrate evidence-based strategies to improve health (Brownson, Colditz, & Proctor, 2012).
A recent survey of seven years of NIH projects indicated that only four percent of these were awarded to nurse scientists (Tinkle, Kimball, Haozous, Shuster, & Meize-Grochowski, 2013). The overriding goal of improvement science is to ensure that quality improvement efforts are based as much on evidence as the best practices they seek to implement. The ISRN is an open research network for the study of improvement strategies in healthcare. The ISRN offers scientists and clinicians from across the nation opportunities to directly engage in conducting studies.
Clinical leaders have unprecedented opportunity to step forward to transform healthcare from a systems perspective, focusing on EBP for clinical effectiveness, patient engagement, and patient safety.
Her multi-site research on team collaboration and frontline engagement in quality improvement is conducted through the national collaboratory, the ISRN.
Barriers include: lack of physician openness to communication, logistic challenges, a lack of professionalism and language barriers. 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.
Yet, because of the change necessary to fully implement and sustain the program across the system supported by organizational culture, a sophisticated implementation plan is required before the evidence-based intervention is adopted across an institution.
Listed among models in Category 1 is the ACE Star Model of Knowledge Transformation (Stevens, 2004); this model is the exemplar for the present discussion of the impact of EBP on nursing models and frameworks. Programs for basic preparation of health professionals were to undergo curriculum revision in order to focus on evidence-based quality improvement processes. These resources have also been incorporated into educational settings as programs are revised to include EBP skills. The strength of these resources is that the approaches and strategies remain closely aligned with the Institute of Medicine’s continuing progress toward better health care.
The second area of translation [“T2”] concerns research aimed at enhancing the adoption of best practices in the community.
Because of the central role that nurses play across all healthcare settings and clinical microsystems, research in this field is highly relevant to the profession. The national network offers a virtual collaboratory in which to study systems improvements in such a way that lessons learned from innovations and quality improvement efforts can be spread for uptake in other settings. The recently-articulated vision for the future of nursing in the Future of Nursing report (IOM, 2011a) focuses on the convergence of knowledge, quality, and new functions in nursing. While agency policy may be set, implementation and sustainment of TeamSTEPPS® remain challenging. Also, professional development programs would need to become widely available to update skills of those professionals who were already in practice. This close alignment reflects the appreciation that nursing must be part of this solution to effect the desired changes; and remaining in the mainstream with other health professions rather than splintering providers into discipline-centric paradigms.
The comparative effectiveness of prevention and treatment strategies are [sic] also an important part of translational science” (Section I, para 2).
The ISRN was developed in response to an NIH call for projects that build infrastructures to advance new fields of science. The recommendation that nurses lead interprofessional teams in improving delivery systems and care brings to the fore the necessity for new competencies, beyond evidence-based practice (EBP), that are requisite as nurses transform healthcare. These competencies focus on utilizing knowledge in clinical decision making and producing research evidence on interventions that promote uptake and use by individual providers and groups of providers. The research collaboratory concept has proven its capacity to conduct multi-site studies and is open to any investigator or collaborator in the field.



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