course materials

1. Discussion: Reducing Wait Time in The Healthcare Facility
Discussion: Reducing Wait Time in The Healthcare Facility ON Discussion: Reducing Wait
Time in The Healthcare FacilityImagine you are on a team at your workplace and have
identified a new best practice to implement. In this assignment, you will describe the steps
of implementing this new practice. This will require you to do some research of your own
about how change comes about in your workplace. You will need to check your policies and
procedures and may need to talk with a supervisor with experience in this area. You will
need to your thoughts on why you think a change needs to occur. This should be done by
using the literature.ObjectivesDifferentiate among research, research utilization, and
evidence-based practiceIdentify the steps of evidence-based
practicePoints: 40ReferencesMinimum of four (4) total references: two (2) references from
required course materials and two (2) peer-reviewed references. All references must be no
older than five years (unless making a specific point using a seminal piece of
information)Peer-reviewed references include references from professional data bases
such as PubMed or CINHAL applicable to population and practice area, along with evidence
based clinical practice guidelines. Examples of unacceptable references are Wikipedia,
UpToDate, Epocrates, Medscape, WebMD, hospital organizations, insurance
recommendations, & secondary clinical databases.Number of Pages/WordsUnless
otherwise specified all papers should have a minimum of 600 words (approximately 2.5
pages) excluding the title and reference pages.Instructor materialitleNursing
ResearchAuthorGeri LoBiondo-Wood; Judith HaberISBN978-0-323-43131-
6PublisherElsevier – Health Sciences DivisionPublication DateJuly 26, 2017BindingTrade
PaperTypePrint developing_an_ebp.pptusing_nursing_research.pdfwritten_critique_of_an_ar
ticle.pdfliterature_critique.pdftools_for_developing_an_Unformatted Attachment
PreviewDeveloping an Evidence-Based Practice Copyright © 2014, 2010, 2006, 2002, 1998,
1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. ?Conscientious and judicious use of
current best evidence in conjunction with clinical expertise and patient values to guide
health care decisions Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by
Mosby, an imprint of Elsevier Inc. 2 ?Research utilization ?Evidence-based practice
encompasses research utilization but also case reports and expert opinion Copyright ©
2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 3
?Multifaceted, systemic process of promoting adoption of evidence-based practices in
delivery of health care services that goes beyond dissemination of evidence-based guideline
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of

2. Elsevier Inc. 4 ?Dissemination: publications, conferences, consultations, and training
programs ?Conscientious and judicious use of current best evidence in conjunction with
clinical expertise and patient values to guide health care decisions Copyright © 2014, 2010,
2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 5 ?Validates
current practice, changes in practice, cost-effectiveness, and quality of care ?High-quality
?Cost-effective ?Outcomes Research Conduct Copyright © 2014, 2010, 2006, 2002, 1998,
1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. Research Utilization 6 ?Questions
about current nursing practice ?Literature review ?Need for investigation ?Clinical research
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of
Elsevier Inc. 7 Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an
imprint of Elsevier Inc. 8 ? Discussion: Reducing Wait Time in The Healthcare
FacilityDevelop and implement improved practice ?Other types of evidence Copyright ©
2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 9
?Priority is given to projects in which a high proportion of practice is guided by research
evidence. ?If a practice change is warranted, changes are implemented using a process of
planned change. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an
imprint of Elsevier Inc. 10 ?EBP is refined based on evaluation data. ?Outcomes are
monitored. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an
imprint of Elsevier Inc. 11 ?Selecting a topic ?Problem-focused triggers ? Quality
improvement data ? Risk-surveillance data ? Benchmarking data ? Financial data ?
Recurrent clinical problems Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986
by Mosby, an imprint of Elsevier Inc. 12 ?Selecting a topic ?Knowledge-focused triggers ?
Reading research ? Listening to scientific papers at research conferences ? Reviewing EBP
guidelines published by federal agencies or specialty organizations Copyright © 2014, 2010,
2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 13 ?Critical that
staff members: ? Be involved in selecting the topic ? View the potential practice as
contributing significantly to patient care Copyright © 2014, 2010, 2006, 2002, 1998, 1994,
1990, 1986 by Mosby, an imprint of Elsevier Inc. 14 ?Forming a team ? Composition of the
team ? Key stakeholders identified Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990,
1986 by Mosby, an imprint of Elsevier Inc. 15 ?Identification of key stakeholders: ? How are
decisions made? ? What types of changes will be needed? ? Who is involved in decision-
making? ? Who is likely to lead and champion implementation? ? Who can influence the
decisions? ? What type of cooperation is needed? Copyright © 2014, 2010, 2006, 2002,
1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 16 ?Question clearly defined: ?
Types of people and patients ? Interventions or exposures ? Outcomes ? Relevant study
designs Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint
of Elsevier Inc. 17 ? Discussion: Reducing Wait Time in The Healthcare FacilityConsider
using PICO ? Patient, population, or problem ? Intervention or treatment ? Comparison
intervention or treatment ? Outcomes Copyright © 2014, 2010, 2006, 2002, 1998, 1994,
1990, 1986 by Mosby, an imprint of Elsevier Inc. 18 ?Evidence examined should include: ?
Clinical studies, meta-analyses, integrative literature reviews, and existing EBP guidelines
?Identify key search terms ?Use the expertise of health science librarians 19 Copyright ©
2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. ?It is

3. helpful to categorize articles and read in this order: ? Clinical (nonresearch) ? Theory
articles ? Integrative and systematic reviews ? Synthesis reports ? EBP guidelines ? Research
articles ? Meta-analyses Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by
Mosby, an imprint of Elsevier Inc. 20 ?There are many grading schemas available but all
address: ? Quality of the individual research ? Strength of the body of evidence Copyright ©
2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 21
?Before reviewing the literature, it is imperative that the team agree on: ? Methods for
categorizing the type of research ? Rating the quality of individual articles ? Grading the
strength of the body of evidence Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990,
1986 by Mosby, an imprint of Elsevier Inc. 22 ?Date of publication or release ?Authors of the
guideline ?Endorsement of the guideline ?Clear purpose of what the guideline covers and
the patient groups for which it was designed Copyright © 2014, 2010, 2006, 2002, 1998,
1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 23 ?Types of evidence (research,
nonresearch) used in formulating the guideline ?Types of research included in formulating
the guideline ?Description of the methods used in grading the evidence Copyright © 2014,
2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 24 ?Search
terms and retrieval methods used to acquire research and nonresearch evidence used in the
guideline ?Well-referenced statements regarding practice ?Comprehensive reference list
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of
Elsevier Inc. 25 ?Review of the guideline by experts ?Whether the guideline has been used
or tested in practice and, if so, with what types of patients and in what types of settings
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of
Elsevier Inc. 26 Discussion: Reducing Wait Time in The Healthcare Facility?Best as a group
project ? Journal club ? Novice and expert ? Assistance from students ? Use graduate
students ? Class project Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by
Mosby, an imprint of Elsevier Inc. 27 ?Use summary tables to synthesize information and
include: ? Study purpose ? Research questions and hypotheses ? Variables studied ?
Description of sample and setting ? Research design ? Methods used to measure each
variable ? Description of the intervention tested ? Findings Copyright © 2014, 2010, 2006,
2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 28 ?Practice changes
based on evidence ?Consider: ? Relevance ? Consistency ? Sample characteristics ?
Feasibility ? Risk-benefit ratio Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986
by Mosby, an imprint of Elsevier Inc. 29 ?Put in writing the evidence base of the practice.
?Clinicians need to know: ? That recommended practices are based on evidence ? The type
of evidence (e.g., randomized clinical trial, expert opinion) used in developing the EBP
standard Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an
imprint of Elsevier Inc. 30 ?Implementing the practice change ? Rogers’ model on diffusion
of innovations ? Nature of the innovation ? Manner in which it is communicated Copyright
© 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 31
?Characteristics of innovations that influence adoption: ? Advantage ? Compatibility ?
Complexity Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an
imprint of Elsevier Inc. 32 ?Strategies to promote adoption: ? Reinvention of the EBP
guideline to fit the local context ? Use of quick reference guides and decision aids ? Use of

4. clinical reminders Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby,
an imprint of Elsevier Inc. 33 ?Methods of communicating change: ? Mass media ?
Educational strategies ? Opinion leaders ? Change champions ? Core groups ? Educational
outreach ? Performance gap assessment ? Audit and feedback Copyright © 2014, 2010,
2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 34 ?Social context
and change ? Strong leadership ? Clear strategic vision ? Good managerial relations ?
Visionary staff in key positions ? A climate conducive to experimentation and risk taking ?
Effective data capture systems ? Available resources to change Copyright © 2014, 2010,
2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 35 ?Goal is to
collect and analyze data with regard to use of a new EBP and then to modify the practice as
necessary. ?Evaluation should include both: ? Process measures ? Outcome evaluation
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of
Elsevier Inc. 36 ?Findings must be provided to clinicians to: ? Reinforce the impact of the
change in practice ? Ensure that they are incorporated into quality improvement programs
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of
Elsevier Inc. 37 ?Education must include knowledge and skills in the use of research
evidence in practice. ?Communicate and integrate EBP into nursing profession. Discussion:
Reducing Wait Time in The Healthcare Facility?Professional responsibility of all nurses to
read and use research in their practice and to communicate with nurse scientists the many
and varied clinical problems for which we do not yet have a scientific base. Copyright ©
2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 38 A.
The researcher B. A direct care provider C. The hospital administrator or CEO D. The head
nurse or CNO E. A mixture of management and direct care providers Copyright © 2014,
2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of Elsevier Inc. 39 A.
Education specialist B. Information technologist C. Opinion leader D. Risk manager
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of
Elsevier Inc. 40 A. Strong leadership B. Clear strategic vision C. Visionary staff in key
positions D. A climate conducive to experimentation and risk taking E. All of the above
Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby, an imprint of
Elsevier Inc. 41 A. Patient outcomes B. Cost savings C. Who is successfully using it D.
Barriers overcome Copyright © 2014, 2010, 2006, 2002, 1998, 1994, 1990, 1986 by Mosby,
an imprint of Elsevier Inc. 42 THE NIGHTINGALE LEGACY CHILD HEALTH 2000
International Pediatric Nursing Conference Friday, June 2, 1995 Heather F. Clarke, RN, PhD
Nursing Research Consultant Registered Nurses Association of British Columbia, Vancouver,
B.C., Canada 1 INTRODUCTION “The time has come the walrus said to talk of many things, of
sailing ships and sealing wax and cabbages and kings”. Indeed the time has come – and its a
time of reform – not just a tinkering around the edges – but of rule breaking; not just
reducing/maintaining costs but of reengineering – doing more with less; not just developing
new technologies but of their creative use. Albert Einstein’s wisdom is as relevant today as
it was decades ago “The significant problems we face cannot be solved at the same level of
thinking we were at when we created them.” The clues that it is a time for calling in the chits
include: – evidence-based practice is “in” – ritual and intuition are “out” –
inappropriate/ineffective diagnostic and therapeutic interventions are not being tolerated –

5. evidence-based tools for decision-making in practice (e.g. CPGs, Care Maps, Critical Paths)
are proliferating and being made widely accessible (e.g. on-line, internet) accountability for
outcomes is demanded of each and every health care profession – the “lone ranger”
practitioner is neither effective nor tolerated – “collaborative” practice is taking on many
shapes and sizes – consumer participation in decision making is not an option – the medical
model (paradigm) has been replaced (by many if not most) by the consumer model
(paradigm) In this era of shared responsibility and cost-consciousness, patient preferences
are a key element of health care decisions and should be considered in the development of
practice guidelines. How come it is taking us so long to recognize these clues – to re-
conceptualize our world of professional nursing – to clearly demonstrate how nursing care
makes a difference – how health care resources and therapeutic nursing interventions are
effectively and efficiently utilized 2 to improve the health status of clients of our health care
system? Clearly, there is a need to improve the research and evidence bases of our practice.
This is the Nightingale Legacy Research and Practice. In Nightingale’s view, nursing should
be a search for truth. She held that the ability to collect accurate information and make
correct observations is essential. “If you cannot get the habit of observation one way or
other, you had better give up being a nurse, for it is not your calling, however kind and
anxious you might be”(1) However, promoting and implementing research-based practice is
not a simple task; nor is it solely reliant upon nurses in clinical practice. There are forces
affecting the advancement of research-based practice within both the health care and
nursing systems. I know Dr. Ritchie is going to address this as well, so I am going to focus
more on some “how come” questions related to research-based nursing practice and discuss
two interrelated processes which must be attended to if the “how come” questions are to be
turned into “why not” questions – or “just do it” approaches. And I am going to address this
with particular emphasis on research utilization. HOW COME? Discussion: Reducing Wait
Time in The Healthcare FacilityHow come there is a gap between knowledge generation and
application? Is it that research is not seen to be relevant to practice? If so, how come we
aren’t getting the relevant research done? Are we not asking the right or relevant
questions? We know nurs es have questions – consider those generated through the
provincial Agency Challenge and agency dinosaur and sacred cow challenges. There are
relevant questions. So – How come they are not being explored? Are researchers not
listening to those questions? And even if they are to some 3 extent – How come clinicians
are not more engaged in answering those questions? Furthermore sometimes there are
answers to the practice relevant questions. How come we’re not using the research?
Example: Internet – IM Injection Sites In the clinical arena the challenges of promoting
research-based practice require a different view of our world – they require us to create a
new future. How we shape our future will depend to great extent on how we perceive the
clues I mentioned earlier – do we see them as threats? or opportunities? do we see this as a
loss? or a gain? I believe it is time to turn our nursing system upside down: From one that is
currently? unstable ? poorly balanced ? difficult for responsive decision-making ?
inappropriate for knowledge diffusion and distillation (promotes evaporation instead) ? not
strategically situated to meet today’s challenges to one that is ? firmly grounded on
evidence and research-based knowledge ? stable ? encourages diffusion and distillation of

6. knowledge 4 ? maximizes the potential of each resource (clinicians, educators,
administrators and researchers) Let’s go back to one of the “how come” questions. How
come we’re not using the research-based knowledge that we have in our practice? ? are we
unaware of the difference it would make – or do we either not believe the research findings
– or not believe that we have “permission” to use them? ? Nurses tend to be perfectionists,
looking for absolute proof of all facts before a piece of research is deemed usable(2) ? do we
not value this aspect of our responsibilities? ? do we lack the infrastructure and/or
competencies to such activity? ? is there a lack of incentive to do so? ? are we unaware of
frameworks available to assist us in the process? In this section of the presentation I will
focus on two processes – diffusion and adoption of innovations and use of research
utilization models/frameworks – processes that have the potential to facilitate the use of
research in nursing. I will tell you a couple of success stories to illustrate my point. We
know that neither the mere existence or dissemination of knowledge nor enforced behavior
change ensure that attitudes, values and behaviors will change (3). Using research findings
in nursing practice can be thought of as adoption of an innovation – a complex process
which involves several stages. 5 Rogers'(4) (1983) theory of diffusion of innovations with
its four successive stages is a good place to start. The first stage – knowledge – occurs as
nurses become aware of the innovation. Next, in the persuasion stage, they form a favorable
or unfavorable attitude toward the innovation. Thirdly, nurses make decisions to adopt or
reject the innovation, at least on a trial basis. If a new practice is mandated without
practitioners moving through these appropriate stages, it is unlikely that the innovation w
ill be implemented consistently or as intended. Consistent application with evaluation
occurs in the fourth confirmation stage – if progress has been successful through the
previous stages. A number of researchers have found that the source for new knowledge
influences the rate at which individuals pass through the first stage. Print-media and
interpersonal contacts (research-oriented conferences and inservice programs and role
models) are most influential in solving clinical problems and adopting innovations
(Brett(5), Coyle and Sokop(6), Means(7), Salasin and Cedar(8), Stinson and Mueller(9)).
Although educational programs are suggested as important methods of research
dissemination, few studies have examined the extent to which research findings are
incorporated into nursing curricula. In 1995, Barta(10) reported on a study that
investigated pediatric nurse educators’ inclusion of evidence-based pain management
techniques in the curriculum. Practices most highly diffused among pediatric nurse
educators were use of pain scales, providing sensory information and teaching self-
comforting strategies. However, only the use of pain scales was in the “include always”
range. The least diffused innovation in this sample was the use of TENS (transcutaneous
electrical nerve stimulation). It’s interesting to note that at the 1992 International Pediatric
Nursing Conference at Child Health 2000, Dr. Leora Kutner11 spoke about desirability 6 (in
fact predicted) that physical methods to ease pain would become more commonplace
including therapeutic touch, massage and TENS – and that this would reflect the growing
appreciation of the research that shows that pain can