Moving from Evidence to Sustainable Practice

Nurses use the principles of evidence-based practice (EBP) to make clinical decisions about patient care. Evidence-based practice is an approach that utilizes the current research to improve healthcare delivery and patient safety (Melynk et al., 2014). Apart from evidence, there are certain factors like values and belief systems that facilitate the use of EBP. Although there is a general expectation for nurses to engage in EBP use, there is a gap in the level of engagement among general nurses and advanced practice nurses. The Quality and Safety Education for Nurses (QSEN) establishes the general competencies for nurses and those that are specific to APNs.

EBP Competencies

There are 13 EBP competencies for general nursing practice and 11 specific competencies for APNs. For general nursing practice, the nurse is expected to question clinical practice to ensure quality care is provided. Using internal evidence, the nurse is supposed to describe clinical problems and formulate clinical questions to guide nursing interventions (Melnyk et al., 2014). Apart from internal evidence, the nurse is entitled to search for external evidence generated from research to inform clinical decisions. The nurse participates in the critical appraisal of research evidence and synthesizes the research to establish its level of evidence. While practicing, the nurse is supposed to collect practice data, integrate gathered evidence, and implement practice changes based on gathered evidence (Melnyk et al., 2014). Lastly, nurses are supposed to disseminate best practices and design strategies to sustain the culture of EBP in their practice settings.

Advanced practice nurses have a greater role than other nurses in the use and implementation of EBP. These nurses conduct a systematic and exhaustive search for evidence and critically appraise the evidence to ensure it answers the right questions (Melnyk et al., 2014). While general nurses search for external evidence to inform clinical decisions, APNs integrate the evidence from nursing and other fields. APNs are observed to lead interdisciplinary teams in applying evidence and guiding the implementation of projects designed by general nurses. Another key difference between general nursing and APN competencies is the formulation of EBP policies and procedures (Melnyk et al., 2014). Additionally, APNs work with other healthcare professionals and mentor other nurses in implementing EBP in their respective healthcare organizations. Lastly, these nurses communicate the best evidence to individuals, groups, and policymakers.

The QSEN competencies apply to the project team implementing EBP in the organization. The first competency involves the description of the clinical problem using internal and external evidence. Secondly, the team must search for evidence, synthesize findings, and use gathered information to improve the identified healthcare challenge. APN competencies that apply to the project team include critical appraisal of evidence and leading interdisciplinary teams in applying synthesized evidence. This project will involve working together with various healthcare teams to ensure survivorship care plans and appropriate referrals are made. The team will also demonstrate competency in measuring process outcomes and implementing strategies to sustain EBP culture in the organization.

Moving from Evidence to Sustainable Practice

Model for Improvement

Designed by the Institute for Healthcare Improvement (IHI), the Model for Improvement (MFI) is a method that is used to improve healthcare processes and outcomes. The first part of the model involves thinking about what needs to be accomplished. It involves asking questions like: What are we trying to accomplish? How will we know a change is an improvement?, and What changes can we make that will result in improvement? (IHI, n.d.). The second part involves doing what has been planned to implement change. The Plan Do Study Act (PDSA) cycle is the proposed model for improving processes.

The team plans to design changes that can ensure the creation of survivorship care plans and referral to the cancer survivorship clinic in Sunshine Cancer Center. To know that the change is effective, there should be an adequate referral of cancer patients to the clinic. Healthcare providers must be educated to provide cancer services to patients including follow-up visits (Soulia et al., 2019). Changes that can be made to ensure the program works include the utilization of technology and addressing barriers like lack of knowledge and buy-in from stakeholders. For example, the use of survivorship care plan software like EQUICARE can serve to streamline service delivery to patients in the clinic.

The second part will involve the utilization of the PDSA cycle. The ‘plan’ phase will include things like reviewing current evidence, assessing barriers, and selecting interventions. The ‘do’ phase will include education of APPs about the survivorship cancer care plan program, implementing the SCP visit process, and adjusting the process based on effectiveness. The ‘study’ phase will involve data collection, review of patient responses, and analysis of results. The ‘act’ phase will depend on the effectiveness of the new change. If the SCP visit is effective, it will be implemented into practice.

Leadership and Management 

Leadership and management are considered to have overlapping roles. The difference between the two is that leaders set the vision while managers follow it. Managers often ensure day to day activities are carried out in the organization. Leaders and managers have a role of listening to employees and removing barriers during the sustainability of EBP projects (Bianchi, et al., 2018). Additionally, leaders and managers identify threats and support employees when necessary.

References

Bianchi, M., Bagnasco, A., Bressan, V., Barisone, M., Timmins, F., Rossi, S., … & Sasso, L. (2018). A review of the role of nurse leadership in promoting and sustaining evidence‐based practice. Journal of Nursing Management, 26(8), 918-932. https://doi.org/10.1111/jonm.12638

Institute for Healthcare Improvement. (n.d.). Science of improvement: How to improve. https://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx

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 a real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence- Based Nursing, 11(1), 5–15. https://doi.org/10.1111/wvn.12021

Soulia, S. L., Duffy, E. A., Morley, K. A., & Smith, E. (2019). Implementation of a Survivorship Care Plan Program in a Community-Based Oncology Clinic. Journal of the advanced practitioner in oncology, 10(7), 665–676. https://doi.org/10.6004/jadpro.2019.10.7.3