10/31/15. WellStar Health System. Effectiveness of an Evidence-Based Practice Nurse Training Program. Background/Significance.

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1 Effeciveness of an Evidence-Based Pracice Nurse Training Program WellSar Healh Sysem -For-Profi 5-Hospial Sysem ~ 1294 Beds Inegraed Healh Sysem: 2 Healh Parks, 1 Nursing Home, 2 Hospices, 8 Urgen Care Ceners, 16 Imaging Ceners, 1 Pediaric Cener LeeAnna Spiva, PhD, RN Paricia Har, PhD, RN Sara Parick, MSN, RN-BC Jessica Waggoner, DNP, CNL, RN Charon Jackson, BSN, RN Jamie Threa, MSN, RN, CCRN, CEN Nicole Jarrell, MSN, RN Behany Roberson, DNP, CNM 180 Physician Offices (850+ Medical Group Providers) 69,900+ Discharges/year 9,500+ Deliveries/year 14,000+ Team Members Revenues > $1.9 Billion Background/Significance Projec Aims Evidence-Based Pracice (EBP) is a problem-solving approach o clinical decision-making ha inegraes scienific evidence from welldesigned research sudies wih clinical experise and paien values 1,2 Despie evidence supporing EBP, research findings have no been consisenly ranslaed ino pracice o improve paien oucomes 3,4 Recen findings from a naional survey found nurse leaders had a srong belief oward EBP; however, lacked resources, suppor and ime hus making EBP implemenaion a low prioriy 5 An essenial elemen o advance and susain EBP was availabiliy of rained EBP menors wihin he organizaion 6-14 Projec Aims To invesigae he effeciveness of a raining program on menors percepions of knowledge, aiude, skill and confidence levels, and organizaional readiness relaed o EBP and research uilizaion and o invesigae he effeciveness of having rained EBP menors available, delivering EBP educaion, and creaing a formalized srucure o enculurae EBP ino clinical pracice on nurses percepion of knowledge, aiude, skill levels, barriers, nursing leadership, organizaional suppor relaed o EBP and research uilizaion Phased Approach Phase I Idenify and Train EBP Menors Phase II Train Clinical Nurses Phase III Combine Phases I and II o Implemen EBP Projec (In Progress) 1

2 Wha We Did Wha We Did Developed Projec Charer o Obained senior nurse leader suppor and shared governance buy-in o CNO leer creaed and disribued o clinical nurses indicaing suppor Idenified and creaed EBP menor responsibiliies including bu no limied o: o Helping saff learn he basics of EBP using Johns Hopkins (JH) EBP model, working wih saff o generae and develop clinical pracice quesions, evidence search, review and criique evidence and evaluae oucomes o Guiding saff o resources (including librarian, funding, expers, ec.) o Guiding saff o incorporae research evidence in pracice o Supporing implemenaion of appropriae pracice changes regarding clinical issue idenified o Guiding saff in communicaing wih key sakeholders including physicians, oher disciplines, and adminisraive leaders o Guiding saff in consulaion wih appropriae inerdeparmenal councils o effec change in clinical pracice when issue(s) idenified Educaion curriculum developed by a docor of philosophy (PhD) prepared CNO, wo PhD prepared nurse researchers, clinical nurse specialis, nurse manager, docor of nursing pracice (DNP) prepared nurse educaors all knowledgeable in he principles of EBP and leadership developmen o Creaed educaion and delivered o menors o Creaed educaion and delivered o nurses Formalized srucure o Job descripions o Annual compeency o Performance appraisal o Clinical advancemen program o Websie wih EBP resources and oolki o Acive lis of EBP menors for saff o conac o Academic parnership wih local nursing school Developed applicaion reviewed/approved by Shared Governance Council for nurses o obain financial assisance o aend conferences and presen QI/research Menor Educaion Training Ouline for Menors Phase I Menor Training Targe Audience: clinical nurse leaders (CNL), clinical nurse specialiss (CNS), clinical educaors and clinical resource nurses received raining in preparaion o serve as EBP menors Didacic insrucion and discussion, webinar, in-person raining, online learning o prepare a foundaion o suppor and foser EBP Par I: Three-hour raining (wo hospials divided raining ino consecuive monhly raining sessions and hree held raining in one session); sared 6/26/2013 wih las raining session compleed 12/10/2014 Subjec Area Inroducion o EBP Guidelines for Implemenaion Searching for Evidence Appraising Evidence Summarizing Evidence and Beyond Objecives Define and discuss origins of EBP, QI and research Describe JH EBP Model and PET (Pracice Quesion, Evidence, Translaion); Describe how o develop an answerable pracice quesion Describe how o search for evidence and available resources Demonsrae appraisal of evidence; Overview of JH ools o criically appraise lieraure (research and non-research); Discuss essenial componens of a research aricle; Evaluae research and non-research aricles using JH appraisal ools; Faciliae group appraisal/evaluaion of research and non-research using he JH EBP process and ools Provide an overview of framework o conduc EBP, QI and Research Describe how o creae a plan for ranslaion, secure resources and common evaluaion mehods o evaluae oucomes Provide an EBP projec example from sar o finish including disseminaion Describe how o move a projec from pracice o absrac o presenaion o publicaion Idenify seps needed for poser/podium presenaion developmen Lis componens of an absrac, poser and podium presenaion Idenify publicaion opions 2

3 Menor Educaion Clinical Nurse Educaion Par II Menor Training included (four sessions held in December 2014): o Idenified sraegies o suppor clinical inquiry o Idenified menor role, behaviors and acions o promoe opimal menoring environmen o Provided overview of resources o ranslae evidence ino daily pracice o Group discussion relaed o poenial barriers he menor may encouner and sraegies o suppor clinical inquiry Par III included (four sessions held in March 2015): o Recap Pars I and II o Review of resources available online, raining modules, websie, funds available o Menor expecaions Clinical nurse raining included four 30-minue online modules designed o equip nurses wih ools and resources o implemen EBP Modules were deployed as follows: o Par I January 31, 2015 o Par II March 3, 2015 o Par III April 1, 2015 o Par IV May 7, 2015 Training Ouline Clinical Nurse Mehods Subjec Area Module I Module II Module III Module IV Objecives Overview of EBP, JH EBP model and how o develop an EBP quesion Overview of available evidence resources, how o search for evidence and demonsrae appraisal and ranslaion of evidence Overview of framework o conduc EBP, qualiy improvemen research; how o creae a plan for ranslaion; secure resources and review of common evaluaion mehods o evaluae oucomes; and review of a compleed EBP projec How o move an EBP projec from pracice o absrac and presen and publicaion Seing/Sample o 5-hospial healhcare sysem locaed in he Souheas Unied Saes o A convenience sample of regisered nurses Human Subjec Proecion o WellSar Research Council and Kennesaw Sae Universiy IRB approvals o Cover Leer Consen - Online Survey (Qualrics) 3

4 Insrumen Descripion Daa Collecion Demographic Survey Evidence-Based Nursing Quesionnaire 15 Confidence Scale 16 Age, race, years pracice, nursing degree, ec 27 iems: scale measure iems ha suppor or hinder he developmen of evidence-based nursing; 5-poin Liker scale 1= srongly disagree o 5= srongly agree subscale mean scores range 1 o 5 and scale is psychomerically sound 5 iems: 1= no opinion o 5= o a grea exen measure nurses perceived confidence in heir knowledge and abiliy o implemen EBP in pracice; higher mean indicae a higher percepion of confidence o implemen EBP; CVI 0.90 and Cronbach s alpha 0.94 Menor Pre: one monh prior o raining Pos: one monh pos raining Demographic survey, Evidence-Based Nursing Quesionnaire and Confidence Scale 29 iems: scale measure perceived barriers o research uilizaion; 5- Barriers o Research poin scale 1= no exen, 4 = grea exen, and 5 = no opinion and scale Uilizaion 17 is psychomerically sound EBP Nurse Leadership 18,19 EBP Work Environmen 18,19 10 iems: scale o measure clinical nurse percepion of suppor provided by nurse manager for EBP; 5-poin scale 1= srongly disagree o 5= srongly agree; subscale mean scores range from 1 o 5 and scale is psychomerically sound 8 iems: scale o measure clinical nurse percepion of suppor provided by organizaion 5-poin scale 1= srongly disagree o 5= srongly agree subscale mean scores range from 1 o 5 and scale is psychomerically sound Nurse Pre: December 31, 2014 o March 31, 2015 Pos: April 1, 2015 o Sepember 1, 2015 Demographic survey, Evidence-Based Nursing Quesionnaire, Barriers o Research Uilizaion, EBP Nurse Leader and EBP Work Environmen Quaniaive Analysis SPSS 22.0 Daa Analysis Pre-analysis daa screening conduced prior o saisical analysis Saisical mehods included frequencies, percenages, means, sandard deviaions, dependen -es A p value of.05 considered saisically significan! EBP Menor Sample Characerisics. N = 66 Range M SD Age (years) Years Experienced < N (%) Gender Female 62 (93.9) Male 4 (6.1) Race Whie/Caucasian 48 (72.7) Black/African American 13 (19.8) Hispanic/Laino 2 (3.0) Asian/Pacific Islander 1 (1.5) Oher 2 (3.0) Degrees Diploma RN 1 (1.5) Associae Degree 18 (27.3) Baccalaureae Degree 33 (50.0) Maser s Degree 13 (19.7) Docorae 1 (1.5) Naional Cerificaion 53 (80.3) 13 (19.7) Belongs o Professional Organizaion 46 (69.7) 20 (30.3) 4

5 Evidence-based nursing quesionnaire (oal score)15 Nurses beliefs & aiudes of research evidence subscale15 EBP Menors Only Dependen -ess Comparing Means and Sandard Deviaions for Pre-Survey and Pos-Survey Scores N Pre-Survey Mean (SD) Pos-Survey Mean (SD) α p (.43) 4.20 (.57) (.54) 4.31 (.62) EBP skills subscale (.59) 4.12 (.60) Nurses knowledge of research language & saisics subscale15 EBP organizaional suppor (readiness) (.85) 3.91 (.78) (.49) 4.21 (.60) Confidence scale (.94) 3.82 (.88) Clinical Nurse Only Findings Module Compleion by Hospial Module 1 Module 2 Module 3 Module 4 Hospial Hospial Hospial Hospial Hospial Toals nurses compleed all modules & 367 compleed all modules and boh pre and pos surveys 273 (74.4%) were clinical nurses who worked full-ime (302, 82.3%) Mos worked day shif (244, 66.5%)! Nurse Sample Characerisics. N = 367 Range M SD Age (years) Years Experienced < N (%) Gender Female 343 (93.5) Male 24 (6.5) Race Whie/Caucasian 266 (72.5) Black/African American 60 (16.3) Hispanic/Laino 6 (1.6) Naive American 6 (1.6) Asian/Pacific Islander 21 (5.7) Oher 8 (2.2) Degrees Diploma RN 34 (9.3) Associae Degree 95 (25.9) Baccalaureae Degree 199 (54.2) Maser s Degree 38 (10.4) Docorae 1 (0.2) Naional Cerificaion 222 (60.5) 144 (39.2) Missing 1 (0.3) Belongs o Professional Organizaion 174 (47.4) 193 (52.6) Nurse Only Dependen -ess Comparing Means and Sandard Deviaions for Pre-Survey and Pos-Survey Scores N Pre-Survey Mean (SD) Pos-Survey Mean (SD) α p EBP Work Environmen scale18, (.67) 4.09 (.63) EBP Nurse Leadership18, (.76) 4.19 (.65) Characerisics of he communicaion: Presenaion & accessibiliy of he research17 Characerisics of he Adoper: The nurse s research values, skills, & awareness17 Characerisics of he Organizaion: Seing, barriers, & limiaions17 Characerisics of he innovaion: Qualiies of he research17 Nurses beliefs & aiudes of research evidence subscale (.76) 2.14 (.88) (.81) 2.15 (.91) (.76) 2.22 (.89) (.96) 2.27 (.98) (.57) 4.26 (.54) EBP skills subscale (.64) 4.09 (.85) Nurses Knowledge of research language & saisics subscale (.76) 3.97 (.76)

6 Take Away Projec Nex Seps Menor program effecive in supporing EBP iniiaives wih nursing saff Formal srucure needed o incorporae EBP ino pracice o Job descripions o Annual compeency o Performance appraisal o Clinical advancemen program Challenges o Compeing nursing prioriies Seek collaboraive relaionships o Academic-Pracice parnerships Phase III is currenly underway a one of he hospials which is a join endeavor beween nurse managers, nurse menors, and clinical nurses o conduc, implemen, and disseminae EBP References 1. Melnyk, B. M., & Fineou-Overhol, E. (2011). Evidence-based pracice in nursing and healhcare: A guide o bes pracice. (2 nd ed.). Philadelphia, PA: Lippinco, Williams, & Wilkins. 2. Newhouse, R.P., Dearhol, S.L., Poe, S.S., Pugh, L.C., & Whie, K. M. (2007). Johns Hopkins Nursing Evidence-Based Pracice Model and Guidelines. Sigma Thea Tau Inernaional, Indianapolis, Indiana. 3. Abrahamson, K.A., Fox, R.L., & Doebbeling, B.N. (2012). Faciliaors and barriers o clinical pracice guideline use among nurses. American Journal of Nursing, 112(7), Solomons, N.M., & Spross, J.A. (2011). Evidence-based pracice barriers and faciliaors from a coninuous qualiy improvemen perspecive: an inegraive review. Journal of Nursing Managemen, 19, Melnyk, B.M., Gallagher-Ford, L., Troseh, M., & Wyngarden, K. (2014). Advisory repor: A naional survey and forum for nurse execuives: leveraging evidence-based pracice o enhance healhcare qualiy, reliabiliy, paien oucomes and cos conainmen. Available a hp://visi.clinicaldecisionsuppor.com/l/7222/ /n9fy1 6. Barnseiner, J.H., Reeder, V.C., Palma, W.H., Preson, A.M., & Walon, M.K. (2010). Promoing evidencebased pracice and ranslaional research. Nursing Adminisraion Quarerly, 34(3), Burns, H.K., Dudjak, L., & Greenhouse, P.K. (2009). Building an evidence-based pracice infrasrucure and culure. A model for rural and communiy hospials. Journal of Nursing Adminisraion, 39(7/8), Brown, C.R., Johnson, A.S., & Appling, S.E. (2011). A ase of nursing research. Journal for Nurses in Saff Developmen, 27(6), E1-E6. 9. Cullen, L., & Adams, S.L. (2012). Planning for implemenaion of evidence-based pracice. Journal of Nursing Adminisraion, 42(4), Kinney, S., Lima, S., McKeever, S., Twomey, B., & Newall, F. (2012). Employing a clinical governance framework o engage nurses in research. Journal Nursing Care Qualiy, 27(3), References 11. Levin, R.F., Fineou-Overhol, E., Melnyk, B.M., Barnes, M., & Veer, M.J. (2011). Fosering evidencebased pracice o improve nurse and cos oucomes in a communiy healh seing. A pilo es of he advancing research and clinical pracice hrough close collaboraion model. Nursing Adminisraion Quarerly, 35(1), Muller, A., McCauley, K., Harringon, P., Jablonski, J., & Srauss, R. (2011). Evidence-based pracice implemenaion sraegy. The cenral role of he clinical nurse specialis. Nursing Adminisraion Quarerly, 35(2), Ruledge, D.N., & Skelon, K. (2011). Clinical exper faciliaors of evidence-based pracice: a communiy hospial program. Journal for Nurses in Saff Developmen, 27(5), Winersgill, W., & Wheeler, E.C. (2012). Engaging nurses in research uilizaion. Journal for Nurses in Saff Developmen, 28(5), E1-E Nagy, S., Lumby, J., McKinley, S., & Macfarlane, C. (2001). Nurses beliefs abou he condiions ha hinder or suppor evidence-based nursing. Inernaional Journal of Nursing Pracice, 7, Spiva, L. (2012). Confidence Scale. Pilo Tesing and Unpublished Work. 17. Funk, S., Champagne, M., Wiese, R., & Tornquis, E. (1991a). BARRIERS: The barriers o research uilizaion scale. Applied Nursing Research, 4(1), Pyrse, Y., McDaniel, A., & Schafer, J. (2014). Psychomeric analysis of wo new scales: he evidencebased pracice nursing leadership and work environmen scales. Worldviews of Evidence-Based Nursing, 11(4), Pryse, Y. (2012). Using evidence based pracice: The relaionship beween work environmen, nursing leadership, and nurses a he bedside. Disseraion Docor of Philosophy in he School of Nursing Indiana Universiy. 6