Chapter009

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 9
Implementing Evidence in
Clinical Settings

EBP in Clinical Practice
• Knowledge must be translated into clinical practice to
improve patient care and outcomes
• The understanding of care based on evidence is often far
removed from clinical practice
• Developing an environment that fosters a culture of EBP
is key

Vision for EBP
• Begin with a vision and an understanding of the goals to
be accomplished
• An image of the future is created to begin the
transformation process
• Often this vision is mandated
− Regulatory bodies
− Insurance providers
− Magnet recognition

Developing a Vision for Change
• Begins with a few passionate individuals
• Involvement of clinical experts and EBP mentors is key
• Preparation and planning are essential
• Sharing the vision for excellence in practice is the most
essential catalyst for promoting EBP

Promoting Engagement
• Engage
− Clinical staff
− Administrators
− Members of other disciplines

Assessing and Eliminating Barriers
• Even when change is welcome, it is stressful
• Stakeholder resistance to change must be explored early
• Barriers to be addressed include
− Inadequate knowledge and skills
− Weak beliefs about the value of EBP
− Poor attitudes toward EBP
− Lack of EBP mentors
− Social and organizational influences
− Economic restrictions

Question
• Tell whether the following statement is true or false.
• Implementation of EBP is the responsibility of graduate-
prepared nurses and members of the nursing leadership.

Answer
• False
• Rationale: Implementation of EBP in the clinical setting is
dependent on broad engagement and participation from
all care providers at all levels, as well as leaders,
administrators, and members of other disciplines.

Question
• What is the most effective strategy for engaging care
providers in a proposed EBP change?
a. Disseminate the evidence that underlies the change
b. Remind staff of their obligation to provide optimal care
c. Bring in EBP experts to speak to staff members
d. Organize discussions and meetings with EBP mentors

Answer
• d. Organize discussions and meetings with EBP mentors
• Rationale: Interactive discussions between EBP mentors
and care providers are an effective way to increase
knowledge and address attitudinal barriers. Other
strategies, such as bringing in outsiders to teach,
disseminating research findings, or telling caregivers that
they are obliged to change, are less likely to engage
them and foster genuine change.

Promoting Engagement
• Prioritize clinical issues
− Start with a clinical issue of direct interest to
clinicians
• Evaluate the infrastructure
− Resources, time, and administrative support
• Develop experts in the EBP process
− Mentorship

Integrating EBP into Practice
Education alone will not change behavior
• Establish formal implementation teams
− Advanced practice and graduate-prepared nurses
• Build excitement
− Focus on the potential improvement in outcomes
• Disseminate the evidence
− Use active and engaging educational techniques

Integrating EBP into Practice (cont’d)
• Develop clinical tools
− Written guidelines, EBP summaries, pre-printed
orders, algorithms, prompts, and reminders
• Pilot test the practice change
• Preserve energy sources
− Develop strategies to maintain excitement and
preserve energy resources
• Choose a timeline carefully
• Celebrate successes along the way

Evaluating Outcomes of EBP Change
• An important, yet often overlooked, step in EBP
• Evaluation indicators
− Outcome measures – quantifiable healthcare results
− Quality care improvement
• Quantify how interventions impact the quality of
patients’ and families’ lives
− Patient-centered quality care
• The value patients and families place on the
healthcare received

Evaluating Outcomes of EBP Change
(cont’d)
• Efficiency of processes
− E.g., appropriate timing of interventions, effective
discharge planning, and efficient utilization of
hospital beds
• Environmental changes
− E.g., evaluation of policy and procedure adherence,
unit resource availability, and healthcare professional
use of supplies and materials
• Professional expertise
− Establishing expectations for adherence to accepted
standards of care essential for best practice

Question
• Which of the following evaluation indicators can be
quantified and statistically analyzed?
a. Environmental changes
b. Professional expertise
c. Outcome measures
d. Patient-centered quality care

Answer
• c. Outcome measures
• Rationale: Outcome measures are quantifiable healthcare
results, such as health status, death, disability, iatrogenic
effects of treatment, health behaviors, and the economic
impact of therapy and illness management.
Environmental changes, professional expertise, and
patient-centered quality care are measures that equally
important, but which are more qualitative in nature.

Summary
• An EBP environment promotes excellence in clinical care
resulting in improvement of patient outcomes
• Transforming a healthcare institution into a setting where
an EBP culture exists requires persistence, patience,
and perseverance

Chapter009

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Chapter009