The Evidence-Based Scholars Program

Report
The Evidence-Based
Scholars Program:
Results and Future Directions
Sheila Cox Sullivan, PhD, RN, VHA-CM
Associate Nurse Executive, Research
Julie A. Brandt, MSN, RN, NE-BC
Associate Director Patient Care Services, Nurse Executive
Central Arkansas Veterans Healthcare System
Little Rock AR
This material is the result of work
supported with resources and the use of
facilities at Central Arkansas Veterans
Healthcare System
Presentation Objectives
• At the end of the presentation, the listener
will be able to:
– Describe the EBP Scholars Program
– Discuss results at CAVHS for the EBP Scholars
Program
– Describe future directions for the program
Purpose
• To determine the effect of mentoring and
release time on the EBP knowledge, skills, and
abilities of staff nurses at CAVHS
• Hidden Agenda: To increase the enculturation
of EBP throughout our medical center
Background
• What is Evidence-Based Practice?
– Intersection of clinical expertise, best available
evidence, and patient values (Sackett, 1996)
– Evidence-based practice is defined as the
conscientious and judicious use of current best
evidence to guide health care decisions for
improving patient outcomes. Use of evidence for
clinical decision-making incorporates patient
values and patient preferences. (Titler, 2008)
$138
Transdisciplinary Model of EBP
From Satterfield, J. M., Spring, B., Brownson, R. C., Mullen, E. J.,
Newhouse, R. P., Walker B. B. et al. (2009) Towards a transdisciplinary
model of evidence-based practice. Milbank Quarterly, 87(2), 368-90.
Best
Available
Evidence
Patient
Values and
Beliefs
EBP
Personal
Clinical
Expertise
The
Problem
Background
• EBP is an essential component of modern
nursing practice
• However, many nurses are not comfortable
being involved in the EBP process
• Literature supports three reasons for this
discomfort:
– Not comfortable with research/research process
– Lack of knowledge about process
– No one who will mentor staff through the process
The Need for Infrastructure
• A systematic method for facilitation of EBP is
necessary for enculturation of EBP to be
effective (Newhouse, 2007; Burns, 2009)
• Clear evidence of leadership support is
required for success (Melnyk & Fineout-Overholt, 2002; Melnyk et
al, 2004; Schultz, 2005)
• Transparency in the process is essential (Newhouse,
2007; Stetler, 2003)
Major Challenge
• Evidence-Based Practice is not Research!
– Research is a "systematic investigation … designed
to develop or contribute to generalizable
knowledge”. [45 CFR 46.102(d)]
– That is, Research generates new knowledge
• EBP is implementation of extant knowledge
into daily processes
• However… let the IRB make that ruling
– Non-Human, Non-Research
– Exempt
Methods - Process
• Provide opportunity for nurses to complete a
EBP project
• Empower chosen nurses to develop a
scholarly methodology in pursuit of EBP
• Develop future mentors for other nurses
• Involve our APNs in EBP
• Address barriers to implementing EBP ideas
• Improve our infrastructure
Methods - Proposal
• Staff would receive one eight hour shift per
pay period to work with ANE/R for one year
• Responsible for showing progress in project
development each year
• Total of 26 days to focus on project
Methods – Application Process
• Proposal included selecting five staff nurses
(one from each clinical service line)
• Required to be a direct care staff RN
• Minimum requirement was BSN preparation
• Staff competed for the positions via an
application process
Methods - Application Process
• Staff completed an Application Form
– Proposal sheet
– References from
• Peer
• Manager
– Identify an APN willing to provide content
expertise and obtain a letter of support
– Concurrence of the ANE
• Manager and ANE signed an acknowledgment
of the release time requirement
Persuasion Strategies
• Built the proposal around the Business Case
for EBP developed by the VHA CNO EBP Goal
Group
– Facilitated by Dr. Anna Alt-White
– Chaired by Beth Taylor
• Brief advertisement:
http://vaww.vanod.med.va.gov/collage/N_EBP/
• EBP and Research are a required part of the
Magnet Journey
Prerequisites to Application
• Proposal included selecting five staff nurses
(one from each clinical service line)
• Required to be a direct care staff RN
• Minimum requirement was BSN preparation
• Staff competed for the positions via an
application process
Application Process
• Staff completed an Application Form
– Proposal sheet
– References from
• Peer
• Manager
– Identify an APN willing to provide content
expertise and obtain a letter of support
– Concurrence of the ANE
• Manager and ANE signed an acknowledgment
of the release time requirement
Selection Process
• The Nursing Research Board conducted a blind
review of the submissions
• No demographic information was solicited or
available
• ANE/R recused from process due to potential
conflict as many applicants sought assistance
during the application process
Selection Process
• Information provided to the Reviewers:
– A table of ideas from each service line
– Associated with the applicant’s idea was:
• the presence or absence of the Master’s prepared
nurse affiliation
• Also associated was the mean score of the reference
forms
• Presence or absence of approval from the ANE
Selection Process
• Instructions were to choose the idea with the
broadest potential impact for our medical
center
• If members were aware of the identity of an
applicant, they were requested to recuse
themselves from the discussion and vote
Measuring KSA of Participants
• Used Upton & Upton’s (2006) Evidence-Based
Practice Scale
• Reliable – Cronbach’s α > 0.7
• Contains 24 items with 3 subscales
• Light participant burden as scale is brief
• Permission obtained from authors to use the
tool
Upton, Dominic and Upton, Penney (2006) Development of an Evidence-Based
Practice Questionnaire for Nurses. Journal of Advanced Nursing, 53 (4). pp. 454-458.
Measurement of KSA
• The participants completed the information
three times
– At the beginning of the program
– Six months later
– One year later (when commitment ends)
Outcomes to Date
• All projects underway with variable levels of
success
• The first cohort of Scholars presented their
work in various settings:
–
–
–
–
CAVHS EBP conferences
CAVHS/UAMS Scholarship Day
Arkansas Nurses Association Conferences
18th Annual National EBP Conference in Iowa
• Total of 7 Podium and 26 Poster Presentations
Overall Scores on EBPQ
7
6
5
4
Baseline
Formative
3
2
1
0
Summative
Changes in Scholar Knowledge
7
6
5
4
Baseline
Formative
3
Summative
2
1
0
Form
Question
Find
Evidence
Appraisal
Synthesis
Evaluation Disseminate
Changes in Scholar Attitudes
7
6
5
4
Baseline
Formative
3
Summative
2
1
0
Workload vs.
Evidence
Open to questions Importance of EBP
Willingness to
change
Change in Scholar Knowledge
7
6
5
4
3
2
1
0
At CAVHS
• 2nd cohort is underway
• At six months in, all projects are underway
• Already have abstracts accepted for one
national and two regional conferences
• Last year’s projects have influenced other sites
within the VISN
• Benefit of infrastructure development greater
than anticipated
VISN-Wide Research Project
• “The Effect of Distance Mentoring on EBP”
• Objectives:
– To determine the effect of implementing the EBP
Scholars Program using a distance mentoring
method
– To determine the effect of the distance mentoring
program on participants’ Knowledge, Skills, and
Attitudes regarding EBP
• VISN 16 funded
Mentors
• Dr. Sullivan: Little Rock; Fayetteville;
Shreveport
• Dr. Mistric and Dr. Richey: Houston; Biloxi
• Dr. Parker: Oklahoma City; Muskogee
• Dr. Bilbrew: Jackson
Expectations of Scholars
• 8 hours release time per pay period to focus
on EBP project
• Complete the Clinical Effectiveness and
Evidence-based Practice Questionnaire (EBPQ)
– Baseline
– 6 months
– Completion
• Meet routinely with assigned mentor
Expectations of Scholars
• Journal activities
• Participate in virtual educational sessions
focusing on ONS Evidence Based Practice
Curriculum
• Develop and implement an EBP guideline
• Disseminate work
Expectations of Mentors
• Develop trusting relationship
• Ensure understanding of the components of
the EBP process
• Guide through the Human Research
Protection Program requirements
• Meet routinely with assigned mentee
• Provide guidance and constructive feedback to
mentee related to EBP processes
EBP Scholar Selection Process
• Participants in the EBP Scholars program:
– Chosen by each Medical Center
– Each Medical Center Nurse Executive (or
designee) :
• Appointed a committee to review all applicants
• After review, the committee chose a Scholar to
participate in the EBP Scholar’s program
Inclusion/Exclusion Criteria
• Inclusion Criteria
• Must be a full-time employee of a VISN 16 medical
center providing direct care at the staff level
• Must have completed a BSN or have successfully
completed the Research course in a BSN program
• Exclusion Criteria
• Nurses functioning away from direct care (i.e. quality
management, research compliance officer, or as
specialists in wound care, fall prevention, and/or
patient safety)
• Nurses in leadership support roles (i.e. Magnet
coordinator, nurse managers, etc.)
EBP Scholar Selection Based on:
• Project potential – Project must:
– Be consistent with medical center nursing mission,
vision, and values
– Be consistent with National Patient Safety Goals
– Potentially affect more than one unit or service
area
– Be within scope of nursing practice
– Be Veteran-centric
Preliminary Information
• We have 9 scholars participating
• Diverse range of ideas
• Already identifying challenges in requirements
for review

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