Clinical Science Investigator’s Toolkit: An Evidence Based Practice Resource for the Bedside Nurse Beth Lacoste RN, APRN, CNS, MSN, CCRN Nicole Jones RN-BC, APRN, CNS-BC, MN, CCRN, CCNS Clinical Nurse Specialists, Critical Care Division East Jefferson General Hospital
The presenters have no financial or commercial conflicts of interest to disclose.
At the end of this presentation, the participant will be able to :
Describe the development and implementation of a toolkit to engage bedside nurses in applying a model for EBP.
Evidence Based Practice What we had in place at EJGH:
It was evident that our practice was based on research, however, many staff nurses could not clearly articulate their involvement in EBP initiatives
With this valuable feedback our magnet journey continues.
Follow-up Center for Nursing Knowledge and Research
Nurse Researcher presented Unit-based introduction to EBP throughout the organization
Staff nurses were encouraged to initiate unit-based clinical inquiry Projects
Focus on staff level implementation of our existing EBP model
CNS Assessment of Staff Nurse Readiness:
What was needed was a practical tool to guide the staff nurse in the process of changing or confirming current practice based on evidence.
The CSI toolkit was developed as a step-by-step guide to applying the EBP model.
Intended for use by nurses with varied educational preparation
Serves to link the nurse with appropriate experts
Workbook that provides practical tips for how and when to consult the nurse researcher, Advanced Practice Nurse, Librarian and leadership resources during the investigation
Serves as a template for systematic documentation so that the findings and outcome of the process can be shared
Steps 1 and 2: Identify a Clinical Question and Clarification/Prioritization
Identifying a clinical problem
Record background, event, or data that led to this issue
Clarifying it in the form of a focused clinical question
Identifying other clinicians/leaders who may already be asking the same question
Step 2: Engage Stakeholders Calling all Detectives…..
Step 3: Evidence Review
First: Institutional Evidence
Search hospital intranet site for current policy/ procedure/ protocol
Second: Evidence-Based Practice Guidelines
Internet search www.guidelines.gov
Professional organization links on hospital intranet
Third: Research Literature
EBSCO, Ovid resources
“ People” EJGH Resources for Searching:
Nurse Researcher (Dr. Bihm x 4854)
Clinical Educators (Center for Nursing Knowledge and Research x 4279)
Clinical Nurse Specialists in your area
Step 3: Evidence Review Research / Literature
Step 4: Evidence Synthesis
Do we have GOOD EVIDENCE to answer our clinical question?
No Yes Is the evidence applicable to your patient population and practice setting? No Yes Do we need a practice change?
See EBP Model
Consult Nurse Researcher
No Yes Report Your Findings- Inform Go to Step VII Planning Practice Change Go to Step V
Levels of Evidence Comprehensive unbiased analysis using a strict scientific design to assess related studies Scholarly analysis of a body of research about a specific issue or topic Research studies in which treatment and control groups are randomly assigned “ gold standard of experimental design” Research studies where a design other than random sampling is used. Merged statistical results from a number of related studies Systematically developed statements by a group of experts to assist practitioner decisions
Meet with your leadership
How do we go about implementing this evidence into our hospital practice?
Change an existing policy?
Create a new policy?
Purchase new equipment?
Do staff education?
Resource: Planning Practice Change Worksheet
Step 5: Planning Practice Change
Step 6: Implement and Evaluate EBP Change
Record pertinent info about:
How and when you made the change
Any outcomes you might have measured following the change
Overall outcome of the change
Step 7: Inform and Integrate into Practice Standards
Make a poster to share the results of your investigation
Bring suggestions for policy changes to the appropriate Shared Governance Council
Bring your toolkit to the Center for Nursing Knowledge and Research – a copy will be made as a lasting resource
Encouraged staff to:
Share your CSI Journey
Convince others that the change is based on good evidence!
Help others bridge the gap between research and practice.
Consider presenting findings at a local or national conference.
CSI-EJ (Clinical Science Investigation)
Objectives At the end of today, you will be able to:
Apply the EJGH EBP Model in clinical practice.
2. Gain skills to effectively search scientific literature using EJGH online resources.
3. Evaluate literature for strength of evidence and applicability to practice.
Date and Publication
Were the methods used logical and well carried out?
Was the study well designed?
Do you think the author’s conclusions are valid?
How does this study relate to your clinical population?
Step 3 – Evidence Review Evidence Critique
EBP Detective Training Workshop Outcomes
Over 60 interdisciplinary team members attended
Identified areas for further education
Research Critique class offered – staff nurses and leadership attended
Statistics class planned for the future
Many units have completed Clinical Science Investigations using the toolkit
EBP Day conducted to share results
Staff posters and completed toolkits
Toolkit presented at National Magnet and Critical Care Nurses Conferences
Ongoing use of the toolkit allows us to refine the toolkit as a resource to engage the bedside nurse in application of the EJGH EBP model.