Text-based Document. Overcoming Buzzwords and Variability Through a Nurse EBP Mentor Program. Downloaded 18-Jun :51:12

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1 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based nursing materials. Take credit for all your work, not just books and journal articles. To learn more, visit Item type Format Title Authors Presentation Text-based Document Overcoming Buzzwords and Variability Through a Nurse EBP Mentor Program Bricker, Diedre Downloaded 18-Jun :51:12 Link to item

2 What Is Evidence-Based Practice (EBP): Overcoming Buzzwords and Variability Through a Nurse EBP Mentor Program Presented by: Kathleen Martinez MSN RN CPN Policy and Procedure Oversight Manager Diedre Bricker MSN RN CRRN CPHIMS Innovations & Outcomes Specialist Donnya Mogensen, MS RN-BC Professional Development Specialist

3 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 Beds 2,200 Registered Nurses 90% Bachelors Degree or higher 47% Certified 300 APRNs Admissions: 16,000 Outpatient visits: 740,000

4 Evidence-Based Practice (EBP) has become a buzzword in healthcare.

5 EBP Improves Patient Outcomes Reduces Costs Standardizes Practice (Fink, Thompson, & Bonnes, 2005; Harrison, Grapham, van den Hoek, Dogherty, Carley, & Angus, 2013; Melnyk, Gallagher-Ford, Long, and Fineout-Overholt, 2014; Stevens, 2013). Clinicians Don t Use EBP Because Too Hard Lack Knowledge Lack Experience (Dogherty, Harrison, Graham, Vandyk, & Keeping- Burke, 2013; Fink et al, 2005; Stevens, 2013).

6 Clinicians enter practice with various backgrounds, knowledge, and educational experiences leading to wide variability on how EBP is practiced at the bedside. No consistency in formal education No consistency in individual leaders in practice Wide variability in the skills, tools, and resources (Fink et al, 2005)

7 Organization adopted EBP language into nursing vision, mission, strategic goals Provide Resources To Facilitate EBP, Research And Quality Evidence-Based Professional Nursing Practice Support Innovation and The Advancement of Nursing Practice Created clear job expectations for utilization of EBP at all levels of nursing through clinical ladder Clinical Ladder Based on QSEN Competencies Four Level Ladder clear expectations for how to demonstrate EBP behavior at each level

8 Preceptor Workshops The BIG Picture New Graduate Nurse Residency Clinical Orientation QSEN Framework in Practice Job Descriptions Competency Assessments QSEN Framework Patient-Centered Care Teamwork & Collaboration Evidence Based Practice Quality Improvement Safety Informatics Clinical Ladder

9 Start of Our Journey: Evaluated the New Graduate Nurse Residency Program Structure-Didactic QI/ Audits/Research Timelines/Process/Rubrics Evaluations

10 Attended EBP Immersion 5-day immersion Create PICOT question Search the literature Rapidly appraise literature Synthesize using standard tools Present findings

11 ARCC Model for System-wide Implementation and Sustainability of EBP (Melnyk Fineout-Overholt, Gallagher-Ford, Stillwell, 2011, p.58).

12 EBP Mentor Program Development New Graduate Nurse Residency Program EPB Project mentoring New Graduate Nurse Residency program evaluation Exploration Literature search Staff development Partnered with Leadership Program evaluation House wide needs assessment Cost / Benefits Funding

13 EBP Training EBP Mentor Program Development Gap analysis Identified key mentors Hosted four, 1-week immersions ( ) Modified residency program Spread Enthusiasm for program Buy in from other disciplines Large interest in becoming mentors (2016) Sustain Hosting 1 more, 1-week immersion (2017) Continuing education

14 EBP project outline Develop PICO questions Level the evidence Synthesis the evidence Design poster Disseminate Mentored by trained EBP experts EBP in the Nurse Residency Program Monthly classroom instruction on steps of EBP Designed tool to assess nurse residents knowledge skills and attitudes related to EBP

15 Clinical Inquiry Council Structure to Support Mentors 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

16 Organizational Assessment Do we have the process and structure to support EBP? Are our people ready for EBP? Are we demonstrating the behaviors of EBP? Organizational Culture & Readiness for System-Wide Integration of Evidence-based Practice Survey (OCRSIEBP) Evidence-based Practice Beliefs Scale Evidence-based Practice Implementation Scale Response rate 17% (n=1013) Baseline, 6 months, 12 months 82% staff RNs; 5% CNS/Educator; 2% APN; 7% manager/administrator; 4% other.

17 Analysis of Organizational Assessment Eleven key questions (thought to represent training impact) were examined at baseline, 6 months, & 12 months using ANOVA 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 evidencebased). K. Oman, 2017

18 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

19 23 Practice Changes Implemented Outcomes What a Difference a Year Makes! 10 Planned Practice Changes 9 New Nurseled Research Studies

20 CHG Bathing In The NICU Improved Shared Governance Meeting Structure Library Improved Literature Search Request Process Alcohol Impregnated Caps House Wide Practice Changes Implemented Standardized Pressure Injury Treatments 6 th 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

21 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 Practice Changes Implemented 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

22 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 Nurse-led Research Studies Development Of Pressure Ulcer Assessment Tool In The Neonatal Population How Does Concept Mapping Compared To Care Planning Affect Critical Thinking/Clinical Reasoning Ability Effectiveness Of Centralized Patient Education Center Analysis Of ST Segment Alarm Monitoring In The Pediatric Population Pediatric Deep Tissue Pressure Injury Prevalence)

23 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), doi: /wvn Fink, R., Thompson, C. J., & Bonnes, D. (2005). Overcoming barriers and promoting the use of research in practice. J Nurs Adm, 35(3), 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: / 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), 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), doi: /j 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), doi: /wvn 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: 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), doi: /j x

24 Contact Information Diedre Bricker, MSN RN CRRN CPHIMS Innovations & Outcomes Donnya Mogensen, MS RN-BC Nurse Residency Manager Kathleen Martinez, MSN RN CPN Clinical Policy Oversight