Chapter15 power point july132012


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Chapter15 power point july132012

  1. 1. Transitioning Evidence to Practice
  2. 2. Evidence Based Practice Models Conduct and Utilization of Research in Nursing (CURN) Stetler Model Iowa Model
  3. 3. CURN Model Designed by the Michigan Nurses Association to develop and test the facilitation of scientific nursing knowledge in clinical practice settings.
  4. 4. CURN ModelAssists nurses to incorporate new research into clinical practice: Identify a patient care problem. Find and assess research-based knowledge to apply to the problem. Adapt and design a nursing practice innovation from the research base. Decide whether to adopt, alter or reject the innovation. Develop the means to extend the new practice beyond the trial. Develop mechanism to maintain the innovation over time.Retrieved from{ABD30A7E-3A16-4 After navigating to this site, type in ‘CURN’ in the search box in the upper right corner.
  5. 5. Stetler Model This is a model of research utilization to facilitate evidence-based practice (EBP). The model formulated a series of critical-thinking and decision-making steps designed to facilitate safe and effective use of research findings.Resource: Stetler, C.B. (2001). Updating the Stetler model of research utilization to facilitate evidence-based practice. Nursing Outlook, 49(6), 272-279.
  6. 6. Stetler Model of Research Utilization to Facilitate EBP, Part I
  7. 7. Stetler Model, Part II
  8. 8. Stetler Model (Cont.) Phase I – Preparatory phase – Define the need for clarity of purpose and potential significance of internal or external factors.  Search, sort and select sources of research evidence  Consider influential factors  Affirm priority  Define purpose and outcomes per issue or catalyst
  9. 9. Stetler Model (Cont.) Phase II – Validation – Reflect studied relationships or variables in terms that could pragmatically be used in daily activities  Perform utilization focused critique & synopsis  Identify and, if applicable, record key study details and qualifiers
  10. 10. Stetler Model (Cont.) Phase III – Comparative Evaluation/Decision Making – Synthesize findings and evaluate per criteria -  Fit of setting  Feasibility  Current practice  Substantiating evidence Decide to use, consider use or not use
  11. 11. Stetler Model (Cont.) Phase IV – Translation/Application – Describes how to implement findings or recommendations –  Confirm type, level and method of application  Use – Review operational details -  Informally – Use in practice  Formally – Identify/design evidence-based documents; package for dissemination; develop EBP change plan, including evaluation  Consider Use  Informally – Obtain targeted practice information; evaluate  Formally – Do formal details as in “Use”; plan and implement a pilot project of use, including evaluation Decide to accept and extend, with or without modification or reject and stop
  12. 12. Stetler Model (Cont.) Phase V – Evaluation –  Evaluate dynamically –  Identify goal for each use  Obtain evidence re: change process and goal- related progress, as well as end result/outcomes  Use iterative evidence to achieve goals  Evaluate as part of routine practice
  13. 13. Iowa Model Provides a guide for clinical decision- making Provides details regarding implementation of evidence-based practice It includes both the practitioner and organizational perspective.
  14. 14. The Iowa Model of Evidence-Based Practice to Promote Quality Care
  15. 15. The Iowa Model of Evidence-Based Practice to Promote Quality Care Problem Focused Triggers  Risk Management Data  Process Improvement Data  Internal/External Benchmarking Data  Financial Data  Identification of Clinical Problem
  16. 16. The Iowa Model of Evidence-Based Practice to Promote Quality Care Knowledge Focused Triggers  New Research or Other Literature  National Agencies or other Organizational Standards and Guidelines  Philosophies of Care  Questions from Institutional Standards Committee
  17. 17. The Iowa Model of Evidence-Based Practice to Promote Quality Care Is this topic a priority for the organization?  If no, consider other triggers  If yes –  Form a team  Assemble relevant research and related literature  Critique and synthesize research for use in practice
  18. 18. The Iowa Model of Evidence-Based Practice to Promote Quality Care Is there a sufficient research base?  If no:  Conduct research  Base practice on other types of evidence such as case reports, expert opinion, scientific principles or theory  If yes – Pilot the change in practice:  Select outcomes to be achieved  Collect baseline data  Design EBP guidelines  Implement EBP on pilot units  Evaluate process and outcomes  Modify the practice guidelines
  19. 19. The Iowa Model of Evidence-Based Practice to Promote Quality Care Is change appropriate for adaptation to practice?  If no – Continue to evaluate quality of care and new knowledge  If yes – Institute the change in practice  Monitor and analyze structure, process and outcome data, including environment, staff, cost, and effect on patient and family Disseminate ResultsSource: Titler, M.G., Steelman, V.J., Budreau, G., Buckwalter, K.C., Goode, C.J. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care. Critical Care Nursing Clinics of North America. 13(4) 13(4) 497-508.
  20. 20. Comparison of the Stetler & Iowa Models Stetler  Iowa  Focus is on how  Explains how individual organizations practitioner change practice implements the based on research research  Prescriptive (step-  Systematic by-step) design design
  21. 21. Read, Think, Do Method of Implementation Not a model, but is a method Acknowledges the complexity of problem-solving processes by looking for –  The evidence  Assessing the value to practice  Addressing the social and cultural milieu of the practice setting to ascertain the best strategies for initiating and sustaining practice changes
  22. 22. Read, Think, Do Method of Implementation Read – Access the breadth of research findings that will sufficiently inform the change process Think – Give critical thought about applicability to the clinical setting Do – Organize the effective implementation of the practice change within a local cultureResource: Winch, S., Henderson, A., & Creedy, D.(2005). Read, think, do!: A method for fitting research evidence into practice. Journal of Advanced Nursing, 31(3), pp. 20- 26.
  23. 23. Barriers to Connecting Research and Practice Organizational Culture Belief Systems Research Related Barriers
  24. 24. Perceived Barriers to Research Utilization:Organizational Culture, Nurses’ Belief Systems and the Research-related Barriers Insufficient time on the job to implement new ideas Nurses feel they do not have the authority to change practice Facilities are inadequate for implementation Statistical analyses are not understandable Insufficient time on the job to read researchSource: Retsas, A. (2000). Barriers to using research evidence in nursing practice. Journal of Advanced Nursing, 31, 599-606.
  25. 25. Perceived Barriers to Research Utilization:Organizational Culture, Nurses’ Belief Systems and the Research-related Barriers Physicians will not cooperate with implementation Nurses are isolated from colleagues with whom to discuss research findings Nurse does not feel capable of evaluating the quality of the research Nurses feel the results cannot be generalized to their setting Other staff are not supportive of implementationSource: Retsas, A. (2000). Barriers to using research evidence in nursing practice. Journal of Advanced Nursing, 31, 599-606.
  26. 26. Strategies Related to Organizational Culture Barriers To facilitate organizational support of EBP –  Allow time for nurses to conduct activities that foster EBP such as time for library searches  Ensure availability of adequate library resources  Start a journal club Resource: Ciliska, et al. as cited in DiCenso, A., Guyatt, G., Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice. Mosby, St. Louis, MO. P. 16.
  27. 27. Journal Clubs Purpose –  To help staff stay abreast of clinical research  To improve clinicians’ ability to critically evaluate published research Process –  Develop a format that will entice busy staff to attend  Select a challenging clinical situation and topic  Select a journal article  Hold the meeting
  28. 28. Journal Club (Continued) Sample Guidelines and Format – Purpose –  To foster excellence in nursing practice by promoting evidence-based practice Goals –  Improve nursing knowledge of current research findings  Foster the application of clinical research and best practice models to nursing practice  Provide a means by which to address clinical issues
  29. 29. Journal Club (Continued) Format for meetings and presentations -  Introduce topic and presenter  Test baseline knowledge and/or seek opinions, attitudes of audience (optional).  Give brief synopsis of following parameters –  Title of article  Study’s purpose  Setting  Population
  30. 30. Journal Club (Continued) Discuss major findings of study Discuss other relevant research that supports or does not support this study Discuss implications of article in terms of impact on nursing practice  Documentation  Delegation  Patient education  Patient satisfaction  Patient/Family centered care  Interdisciplinary collaboration
  31. 31. Journal Club (Continued) What is the relevance of this article to our practice? Should we change our practice based on this information? If yes, then – Group discussion/Questions EvaluationsResource: St. Pierre, J. (2005). Changing nursing practice through a nursing journal club. MedicalSurgical Nursing, 14(5). 390 – 392.
  32. 32. Strategies Related to Belief System Barriers Simple dissemination of information is generally ineffective. Multi-faceted approaches are more likely to succeed.  One-to-one sessions between experts such as nurse facilitators and the staff who will implement changes  Manual and computerized reminders of the change  Educational meetings that are interactive  Audit and feedback on a regular basis Resource: DiCenso, A., Guyatt, G., Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice. St. Louis, MO: Mosby, p. 17.
  33. 33. Strategies Related to Research- related Barriers Research related barriers include nurses’ lack of understanding of how to read and critique research studies  Foster nurse researcher positions or nursing research committees  Link staff nurses and advanced practice nurses with nursing researcher faculty at universities  Provide training on how to conduct searches, read and critique research studies Resource: Ciliska, et al. as cited in DiCenso, A., Guyatt, G., Ciliska, D. (2005). Evidence-based nursing: A guide to clinical practice. St. Louis, MO: Mosby. P. 16.
  34. 34. Making Change HappenWhat is change?  To give a completely different form or appearance to; transformResource: The American Heritage® Dictionary of the English Language, Fourth Edition. Retrieved from website:
  35. 35. Making Change Happen Engaging others to change  Kotter’s Change Model Change has an emotional and a situational componentSource: Campbell, R.J. (2008). Change management in health care. Health Care Manager. 27(1), 23-39. Manager. 27(1),
  36. 36. Making Change Happen Kotter’s Change Model Phase 1 - Creating a climate for change  Establish Urgency  Create Coalition  Develop Vision Phase 2 - Engaging and enabling the whole organization  Communicate Vision  Empower Action  Generate short-term wins Phase 3 - Implementing and sustaining change  Consolidate Gains/Produce more  Anchor Approaches
  37. 37. Kotter’s Change Model Establish Urgency – “Making sure that sufficient people act with sufficient urgency – with on your toes behavior that looks for opportunities and problems, that energizes colleagues, that beams a sense of let’s go!”
  38. 38. Kotter’s Change Model Create Coalition – Build a guiding team.  Members must –  Have relevant knowledge about the change.  Be willing to establish credibility with peers.  Have expertise regarding the inner workings of the organization.  Have formal authority.  Have Leadership skill.
  39. 39. Kotter’s Change Model Develop Vision – The vision must be expressed in a clear, concise statement about the direction in which the organization is headed. Paint a picture of the future. Focus on how service will be improved. Must call on emotion and motivate to action.
  40. 40. Kotter’s Change Model Communicate Vision –  Develop methods of communication that address any negative feelings.  Help employees to think and act in accordance with the new direction.  Identify groups affected by the change and project their needs, concerns and roles.  Continuum of feelings: Awareness, Understanding, Collaboration, Commitment, Advocacy.
  41. 41. Kotter’s Change Model Empower Action – Give team the power to eliminate barriers such as supervisors, the system, mental barriers and lack of information.
  42. 42. Kotter’s Change Model Generate short-term wins – Choose and complete tasks that show the change management project is succeeding. Teams should achieve visible, meaningful and unambiguous progress quickly.
  43. 43. Kotter’s Change Model Consolidate Gains/Produce More – Include ongoing comparison to competitors to re-energize the change. Anchor approaches – Culture change comes when a new way of operating has been shown to succeed over a period of time.
  44. 44. Kotter’s Phases of Change Model Worksheet– Sample Completed ToolIntervention to be implemented: A distraction-free zone for medication administration will be established.Stakeholders identified: Nurses, Support staff, Physicians, patients, families.Policy and procedures identified as needed or updated: Medication Administration policy – Add: Nurses will wear a red vest when administering medications. When the vest is on, there may be no interruptions of the nurse.
  45. 45. Kotter’s Phases of Change Model Worksheet– Sample Completed ToolProject Establish Create Develop Communicate Empower Generate Consolidate Anchor Coalition Vision Action Short Gains ApproachesName Urgency Vision term Produce Wins MorePilot - Creating Develop Assemble How does Develop a Team Compile Expand pilot Discuss ata Distraction Power Point Team – this affect: Power Point works 1:1 and to additional staff meetingFree Zone presentation – Director of Nurses, presentation with staff present units after 3 monthly forDuring Med #1 leading Nurses, Support staff, showing the on first med error months. 6 months.Administration cause of med Nurse Physicians, process of med day of rates Team errors in nation Manager, Patients, administration pilot. monthly conducts & our hospital. Staff nurse Care, in distraction Blog set and report audit of Include from each Competitors, free zone up where at unit implementati statistics. shift on Revenues staff can meeting. on monthly Highlight pilot unit Develop anonymously Publish by direct specific errors. vision send article observation questions of med pass. statement or about pilot concerns in hospital to team. newsletter