MSN

1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 14
Teaching Evidence-Based
Practice in Clinical Settings

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Need for Teaching EBP in Clinical
Settings
• Changes in practice have often been mandated to
clinicians versus being generated by clinicians
• There has been little consideration of the basic paradigm
from which clinicians practice
• Regulatory and accrediting agencies have indicated that
organizations that are practicing based on evidence will
reap rewards
• EBP makes sense from a safety perspective and from a
best care perspective

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Challenges in the Clinical Setting
• A commonly-cited barrier is the skill level of the
individual nurse
− Related to nurse education level and demographics
− Many nurses received no teaching about EBP during
nursing school
• Many nurses have difficulty interpreting and applying
study findings
• Librarians are rarely consulted

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Challenges in the Clinical Setting (cont’d)
• Stressors related to shortages in the RN workforce and
the demands of long shifts and increased patient loads
• Lack of time
• Nurses report that managers do not account for the
limitations of the practice setting for application of EBP
• Competing organizational priorities
The crux of teaching nurses and other healthcare
providers about EBP is buy-in

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• Tell whether the following statement is true or false.
• Providing nurses with adequate time and education will
result in the implementation of EBP in a practice setting.

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• False
• Rationale: Numerous barriers and challenges can
complicate or impede the implementation of EBP in
practice settings. Providing nurses with the time and
knowledge to implement EBP is necessary, but these
measures alone are unlikely to result in a fundamental
change in practice.

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Organizational Readiness for Teaching
Evidence-Based Practice
• The organization must commit to provide the resources
and leadership necessary to transform the culture to one
that demonstrates EBP daily
− Transformational leadership
• Shared governance can foster mutual goals
− An EBP or Research/EBP Council can address clinical
issues with evidence
− A Practice Council can take evidence compiled and
synthesized by the EBP Council and operationalize it

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• A hospital’s EBP Council is collaborating with nurses in
light of a recent clinical controversy. Which of the
following roles should the council primarily perform?
a. Teaching nurses about the mandate for basing practice
on evidence
b. Performing valid and reliable research to answer the
clinical question
c. Utilizing existing research to inform a potential change in
practice
d. Eliciting patient preferences to combine with clinical
expertise and research evidence

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• c. Utilizing existing research to inform a potential change
in practice
• Rationale: The central role of an EBP Council is to
address clinical issues with evidence. At times, the
council may choose to educate nurses about EBP or elicit
patient preferences, but the main function is to mobilize
evidence. EBP Councils are unlikely to perform original
research.

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Essential Resources for Teaching EBP
• Begin with assessment of the resources that are available
or could be dedicated to EBP
− Emphasis on human resources
− Numerous tutorials and courses are available
• Assess individuals’ computer and informatics literacy
• Ensure that you have a clinical or medical librarian on the
teaching team
− Electronic access to evidence is vital
• Financial support

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Strategies for Teaching Evidence-Based
Practice
• Begin by engaging leaders, unit educators, and advanced
practice nurses
− Support from managers is vital
• Once a team of educators and EBP mentors has been
developed, begin to educate bedside caregivers
− EBP education via seminars, self-directed learning,
journal clubs, committee structure
− Computer education
• Teaching EBP in the clinical setting also can be enhanced
through partnerships with academic institutions

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
• A hospital unit has an identified need to increase
caregivers’ familiarity and skills surrounding evidence-
based practice. An educational initiative to address this
deficit should focus first on whom?
a. The most experienced nurses on the unit
b. The manager of the unit
c. Academic experts from a local university
d. The hospital’s medical librarian

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
• b. The manager of the unit
• Rationale: It is important to engage managers, unit
educators, and advanced practice nurses at the outset of
EBP education because these individuals serve as models
of change for point-of-care staff. Staff nurses, librarians,
and academic experts may be consulted after engaging
these leaders.

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Summary
• Teaching EBP is a continuous process that will result in
improved patient care outcomes, professional growth,
and an empowered clinical staff
• It is not accomplished through one program, one
committee, or one project
• Teaching EBP in a clinical setting requires commitment,
diligence, enthusiasm, creativity, and team work