Description
Pease gimme strong paragraphs with clear ideas. I need good thoughts with concatenated ideas.
DEVELOPING A CULTURE OF EVIDENCE-BASED PRACTICE
As your EBP skills grow, you may be called upon to share your expertise with others. While EBP practice is often conducted with unique outcomes in mind, EBP practitioners who share their results can both add to the general body of knowledge and serve as an advocate for the application of EBP.
In this Discussion, you will explore strategies for disseminating EBP within your organization, community, or industry.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To Prepare:
Review the Resources and reflect on the various strategies presented throughout the course that may be helpful in disseminating effective and widely cited EBP.
This may include: unit-level or organizational-level presentations, poster presentations, and podium presentations at organizational, local, regional, state, and national levels, as well as publication in peer-reviewed journals.
Reflect on which type of dissemination strategy you might use to communicate EBP.
BY DAY 3 OF WEEK 9
Post at least two dissemination strategies you would be most inclined to use and explain why. Explain which dissemination strategies you would be least inclined to use and explain why. Identify at least two barriers you might encounter when using the dissemination strategies you are most inclined to use. Be specific and provide examples. Explain how you might overcome the barriers you identified.
THIS IS WHAT WAS MENTIONED FROM MY PROFESSOR ON THE LAST ASSIGNMENT AND I RECEIVED A 67%, ALSO I’VE INCLOSED THE RUBIC AS WELL TO FOLLOW ALONE
You have presented a critical appraisal of four peer-reviewed articles within the Critical Appraisal Tool Worksheet Template. The review was underdeveloped and the studies not specific to the PICOT Based on your appraisal you suggested a best practice however you are making a leap with the “evidence”. These studies suggest there is a link between stress and burnout but they do not investigate the effect of a stress reduction program on decrease in burnout. The required course resources were not included.
NURS_6052_Module05_Week09_Discussion_Rubric
NURS_6052_Module05_Week09_Discussion_Rubric
Criteria Ratings Pts
Main Posting
view longer description
50 to >44 pts
Excellent
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. … Supported by at least three current, credible sources. … Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
44 to >39 pts
Good
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. … At least 75% of post has exceptional depth and breadth. … Supported by at least three credible sources. … Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
39 to >34 pts
Fair
Responds to some of the discussion question(s). … One or two criteria are not addressed or are superficially addressed. … Is somewhat lacking reflection and critical analysis and synthesis. …Somewhat represents knowledge gained from the course readings for the module. … Post is cited with two credible sources. … Written somewhat concisely; may contain more than two spelling or grammatical errors. … Contains some APA formatting errors.
34 to >0 pts
Poor
Does not respond to the discussion question(s) adequately. … Lacks depth or superficially addresses criteria. … Lacks reflection and critical analysis and synthesis. … Does not represent knowledge gained from the course readings for the module. … Contains only one or no credible sources. … Not written clearly or concisely. …Contains more than two spelling or grammatical errors. … Does not adhere to current APA manual writing rules and style.
/ 50 pts
Main Post: Timeliness
view longer description
10 to >0 pts
Excellent
Posts main post by day 3.
0 pts
Poor
Does not post by day 3.
/ 10 pts
First Response
view longer description
18 to >16 pts
Excellent
Response exhibits synthesis, critical thinking, and application to practice settings. … Responds fully to questions posed by faculty. …Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. … Demonstrates synthesis and understanding of learning objectives. … Communication is professional and respectful to colleagues. … Responses to faculty questions are fully answered, if posed. … Response is effectively written in standard, edited English.
16 to >14 pts
Good
Response exhibits critical thinking and application to practice settings. … Communication is professional and respectful to colleagues. … Responses to faculty questions are answered, if posed. … Provides clear, concise opinions and ideas that are supported by two or more credible sources. … Response is effectively written in standard, edited English.
14 to >12 pts
Fair
Response is on topic and may have some depth. … Responses posted in the discussion may lack effective professional communication. … Responses to faculty questions are somewhat answered, if posed. … Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
12 to >0 pts
Poor
Response may not be on topic and lacks depth. … Responses posted in the discussion lack effective professional communication. … Responses to faculty questions are missing. … No credible sources are cited.
/ 18 pts
Second Response
view longer description
17 to >15 pts
Excellent
Response exhibits synthesis, critical thinking, and application to practice settings. … Responds fully to questions posed by faculty. … Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. … Demonstrates synthesis and understanding of learning objectives. … Communication is professional and respectful to colleagues. … Responses to faculty questions are fully answered, if posed. … Response is effectively written in standard, edited English.
15 to >13 pts
Good
Response exhibits critical thinking and application to practice settings. … Communication is professional and respectful to colleagues. … Responses to faculty questions are answered, if posed. … Provides clear, concise opinions and ideas that are supported by two or more credible sources. … Response is effectively written in standard, edited English.
13 to >11 pts
Fair
Response is on topic and may have some depth. … Responses posted in the discussion may lack effective professional communication. … Responses to faculty questions are somewhat answered, if posed. … Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
11 to >0 pts
Poor
Response may not be on topic and lacks depth. … Responses posted in the discussion lack effective professional communication. … Responses to faculty questions are missing. … No credible sources are cited.
/ 17 pts
Participation
view longer description
5 to >0 pts
Excellent
Meets requirements for participation by posting on three different days.
0 pts
Poor
Does not meet requirements for participation by posting on 3 different days.
/ 5 pts
Total Points: 0
FROM ANNOUCEMENTS;
Today we begin week 9 in the course, and the assignment is a discussion forum. Here is a reminder of the requirements for that forum:
By Wednesday of week 9 Postat least two dissemination strategies (for example a power-point, or podium presentation, or poster, etc) you would be most inclined to use to introduce an evidence-based practice into a workplace and give rationale for your selections.
Explain which dissemination strategies you would be least inclined to use and explain why.
Identify at least two barriers you might encounter when using the dissemination strategies, you are most inclined to use. Be specific and provide examples. For example it might be difficult to get busy nurses together for a presentation in person, how could you overcome that)
Explain how you might overcome the barriers you identified.
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Evidence-Based Practice, Step by Step:
Implementing an Evidence-Based Practice Change
Gallagher-Ford, Lynn MSN, RN, NE-BCFineout-Overholt, Ellen PhD, RN, FNAP,
FAANMelnyk, Bernadette Mazurek PhD, RN, CPNP/PMHNP, FNAP, FAANStillwell, Susan B.
DNP, RN, CNEAuthor Information
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Abstract
This is the ninth article in a series from the Arizona State University College of Nursing and Health
Innovation’s Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a
problem-solving approach to the delivery of health care that integrates the best evidence from studies and
patient care data with clinician expertise and patient preferences and values. When delivered in a context of
caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be
achieved.The purpose of this series is to give nurses the knowledge and skills they need to implement EBP
consistently, one step at a time. Articles will appear every other month to allow you time to incorporate
information as you work toward implementing EBP at your institution. Also, we’ve scheduled “Chat with the
Authors” calls every few months to provide a direct line to the experts to help you resolve questions. Details
about how to participate in the next call will be published with May’s Evidence-Based Practice, Step by Step.
In January’s evidence-based practice (EBP) article, Rebecca R., our hypothetical staff nurse,
Carlos A., her hospital’s expert EBP mentor, and Chen M., Rebecca’s nurse colleague, began to
develop their plan for implementing a rapid response team (RRT) at their institution. They
clearly identified the purpose of their RRT project, the key stakeholders, and the various
outcomes to be measured, and they learned their internal review board’s requirements for
reviewing their proposal. To determine their next steps, the team consults their EBP
Implementation Plan (see Figure 1 in “Following the Evidence: Planning for Sustainable
Change,” January). They’ll be working on items in checkpoints six and seven: specifically,
engaging the stakeholders, getting administrative support, and preparing for and conducting the
stakeholder kick-off meeting.
ENGAGING THE STAKEHOLDERS
Carlos, Rebecca, and Chen reach out to the key stakeholders to tell them about the RRT project
by meeting with them in their offices or calling them on the phone. Carlos leads the team through
a discussion of strategies to promote success in this critical step in the implementation process
(see Strategies to Engage Stakeholders). One of the strategies, connect in a collaborative way,
seems especially applicable to this project. Each team member is able to meet with a stakeholder
in person, fill them in on the RRT project, describe the purpose of an RRT, discuss their role in
the project, and answer any questions. They also tell each stakeholder about the initial project
meeting to be held in a few weeks.
Box
No caption available.In anticipation of the stakeholder kick-off meeting, Carlos and the team
discuss the fundamentals of preparing for an important meeting, such as how to set up an agenda,
draft key documents, and conduct the meeting. They begin to discuss a time and date for the
meeting. Carlos suggests that Rebecca and Chen meet with their nurse manager to update her on
the project’s progress and request her help in scheduling the meeting.
SECURING ADMINISTRATIVE SUPPORT
After Rebecca updates her manager, Pat M., on the RRT project, Pat says she’s impressed by the
team’s work to date and offers to help them move the project forward. She suggests that, since
they’ve already invited the stakeholders to the upcoming meeting, they use e-mail to
communicate the meeting’s time, date, and place. As they draft this e-mail together, Pat shares
the following tips to improve its effectiveness:
• communicate the essence and importance of the e-mail in the subject line
• write an e-mail that’s engaging, but brief and to the point
• introduce yourself
• explain the project
• welcome the recipients to the project and/or team and invite them to the meeting
• explain why their attendance is critical
• request that they read certain materials prior to the meeting (and attach those documents
to the e-mail)
• let them know whom to contact with questions
• request that they RSVP
• thank them for their participation
Box
No caption available.Before they send the e-mail (see Sample E-mail to RRT and
Stakeholders), the team wants to make sure they don’t miss anyone, so they review and include
all of the RRT members and stakeholders. They realize that it’s important to invite the manager
of each of the stakeholders and disciplines represented on the RRT and ask them to also bring a
staff representative to the meeting. In addition, they copy the administrative directors of the
stakeholder departments on the e-mail to ensure that they’re fully aware of the project.
PREPARING FOR THE KICK-OFF MEETING
The group determines that the draft documents they’ll need to prepare for the stakeholder kickoff meeting are:
• an agenda for the meeting
• the RRT protocol
• an outcomes measurement plan
• an education plan
• an implementation timeline
• a projected budget
To expedite completion of the documents, the team divides them up among themselves. Chen
volunteers to draft the RRT protocol and outcomes measurement plan. Carlos assures her that
he’ll guide her through each step. Rebecca decides to partner with her unit educator to draft the
education plan. Carlos agrees to take the lead in drafting the meeting agenda, implementation
timeline, and projected budget, but says that since this is a great learning opportunity, he wants
Rebecca and Chen to be part of the drafting process.Drafting documents. Carlos tells the team
that the purpose of a draft is to initiate discussion and give the stakeholders an opportunity to
have input into the final product. All feedback is a positive sign of the stakeholders’ involvement,
he says, and shouldn’t be perceived as criticism. Carlos also offers to look for any templates from
other EBP projects that may be helpful in drafting the documents. He tells Rebecca and Chen
that he’s confident they’ll do a great job and shares his excitement at how the team has progressed
in planning an EBP practice change.RRT protocol. Chen starts to draft the RRT protocol using
one of the hospital’s protocols as a template for the format, as well as definitions and examples of
protocols, policies, and procedures from other organizations and the literature. She returns to the
articles from the team’s original literature search (see “Critical Appraisal of the Evidence: Part I,”
July 2010) to see if there is information, previously appraised, that will be helpful in this current
step in the process. She recalls that the team had set aside some articles because they didn’t
directly answer the PICOT question about whether to implement an RRT, but they did have
valuable information on how to implement an RRT. In reviewing these articles, Chen selects one
that’s a review of the literature, though not a systematic review, that includes many examples of
RRT membership rosters and protocols used in other hospitals, and which will be helpful in
drafting her RRT protocol document.1 Chen includes this expert opinion article because the
information it contains is consistent with the higher-level evidence already being used in the
project. Using both higher and lower levels of evidence, when appropriate, allows the team to
use the best information available in formulating their RRT protocol.As she writes, Chen
discovers that their hospital’s protocols and other practice documents don’t include a section on
supporting evidence. Knowing that evidence is critically important to the RRT protocol, she
discusses this with the clinical practice council representative from her unit who advises her to
add the section to her draft document. He promises to present this issue at the next council
meeting and obtain the council’s approval to add an evidence section to all future practice
documents. Chen reviews the finished product before she submits it for the team’s review
(see RRT Protocol Draft for Review1–10).
Box
No caption available.Outcomes measurement plan. Based on the appraised evidence and the
many discussions Rebecca and Chen have had about it, Chen drafts a document that lists the
outcomes the team will measure to demonstrate the success of their project, where they’ll obtain
this information, and who will gather it (see Table 1). In drafting this plan, Chen realizes that
they don’t have all the information they need, and she’s concerned that they’re not ready to move
forward with the stakeholder kick-off meeting. But when Chen calls Carlos and shares her
concern, Carlos reminds her that the document is a draft and that the required information will be
addressed at the meeting.
Table 1. Plan for Measuring RRT Success (Draft for Discussion)
Education plan. Rebecca reaches out to Susan B., the clinical educator on her unit, and requests
her help in drafting the education plan. Susan tells Rebecca how much she enjoys the opportunity
to work collaboratively with staff nurses on education projects and how happy she is to see an
EBP project being implemented. Rebecca shares her RRT project folder (containing all the
information relative to the project) with Susan, focusing on the education about the project she
thinks the staff will need. Susan commends the team for its efforts, as a good deal of the
necessary work is already done. She asks Rebecca to clarify both the ultimate goal of the project
and what’s most important to the team about its rollout on the unit. Rebecca thoughtfully
responds that the ultimate goal is to ensure that patients receive the best care possible. What’s
most important about its rollout is that the staff sees the value of an RRT to the patients and its
positive impact on their own workload. She adds that it’s important to her that the project be
conducted in a way that feels positive to the staff as they work toward sustainable changes in
their practices.Susan and Rebecca discuss which clinicians will need education on the RRT.
They plan to use a variety of mechanisms, including in-services, e-mails, newsletters, and flyers.
From their conversation, Susan agrees to draft an education plan using a template she developed
for this purpose. The template prompts her to put in key elements for planning an education
program: learner objectives, key content, methodology, faculty, materials, time frame, and room
location. Susan fills the template with information Rebecca has given her, adding information
she knows already from her experience as an educator. When Rebecca and Susan meet to review
the plan, Rebecca is amazed to see how their earlier conversation has been transformed into a
comprehensive document (see the Education Plan for RRT
Implementation at http://links.lww.com/AJN/A19).Agenda and timeline. The team meets to
draft the meeting agenda, implementation timeline, and budget. Carlos explains the purposes of a
meeting agenda: to serve as a guide for the participants and to promote productivity and
efficiency. They draft an agenda that includes the key issues to be shared with the stakeholders
as well as time for questions, feedback, and discussion (see the Rapid Response Team Kick-off
Meeting Agenda at http://links.lww.com/AJN/A20).Carlos describes how the timeline creates a
structure to guide the project (see Table 2 at http://links.lww.com/AJN/A21). The team further
discusses how it can maintain the project’s momentum by keeping it moving forward while at the
same time accommodate unexpected delays or resistance. There are a few items on the timeline
that Carlos thinks may be underestimated—for example, the team may need more than a month
to meet with other departments because of already heavily scheduled calendars—but he decides
to let it stand as drafted, knowing that it’s a guide and can be adjusted as the need
arises.Budget. Carlos discusses the budget with the team. Rebecca shares a list of what she thinks
they’ll need for the project and the team decides to put this information into a table format so
they can more easily identify any missing information. Before they construct the table, they walk
through an imaginary RRT call to be sure they’ve thought of all the budget implications of the
project. They realize they didn’t include the cost of each employee attending an education
session, so they add that figure to the budget. They also realize that they’re missing hourly pay
rates for the different types of employees involved. Carlos tells Rebecca that he’ll work with the
Human Resources Department to obtain this information before the meeting so they can
complete the budget (see Table 3).
Table 3. RRT Project Budget Draft (Draft for Discussion)
REVIEWING THEIR WORK
The next time they meet, the EBP team reviews the agenda for the meeting and the documents
they’ll be presenting. The clerical person on Rebecca and Chen’s floor (sometimes called the unit
secretary) has kept a record of who’s attending the meeting and the team is pleased that most of
the stakeholders are coming. Carlos informs the team that he received notification that their
internal review board submission has been approved. They’re excited to check that step off on
their EBP Implementation Plan.Carlos suggests that they discuss the kick-off meeting in detail
and brainstorm how to prepare for any negative responses to their project that might occur.
Rebecca and Chen remark that they’ve never considered that someone might not like the idea of
an RRT. Carlos says he’s not surprised; often the passion that builds around an EBP project and
the hard work put into it precludes taking time to think about “why not.” The team talks about
the importance of stopping occasionally during any project to assess the environment and
participants, recognizing that people often have different perspectives and that everyone may not
support a change. Carlos reminds the team that people may simply resist changing the routine,
and that this can lead to the sabotage of a new idea. As they explore this possible resistance,
Rebecca shares her concern that with everyone in the hospital so busy, adding something new
may be too stressful for some people. Carlos tells Rebecca and Chen that helping project
participants realize they’ll be doing the same thing they’ve been doing, just in a more efficient
and effective way, is generally successful in helping them accept a new process. He reminds
them that many of the people on the RRT are the same people who currently take care of patients
if they code or are admitted to the ICU; however, with the RRT protocol, they’ll be intervening
earlier to improve patients’ outcomes. The team feels confident that, if needed, they can use this
approach at the kick-off meeting.
CONDUCTING THE KICK-OFF MEETING
Rebecca and Chen are both nervous and excited about the meeting. Carlos has made sure they’re
well prepared by helping them set up the meeting room, computer, PowerPoint presentation, and
handout packets containing the agenda and draft documents. The team is ready, and they’ve
placed themselves at the head of the table so they can be visible and accessible. As the invitees
arrive, they welcome each one individually, thanking them for participating in this important
meeting. The team makes sure that the meeting is guided by the agenda and moves along through
the presentation of information to thoughtful questions and a lively discussion.Join the EBP team
next time as they launch the RRT project and tackle the real-world issues of project
implementation.
REFERENCE
• 1. Choo CL, et al. Rapid response team: a proactive strategy in managing
haemodynamically unstable adult patients in the acute care hospitals.
ARTICLES
SUBSCRIBED
Organizational Change Strategies for EvidenceBased Practice
Newhouse, Robin P. PhD, RN, CNA, CNORDearholt, Sandi MS, RNPoe, Stephanie MScN,
RNPugh, Linda C. PhD, RNC, FAANWhite, Kathleen M. PhD, RN, CNAA,BCAuthor
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Abstract
Evidence-based practice, a crucial competency for healthcare providers and a basic force in Magnet hospitals,
results in better patient outcomes. The authors describe the strategic approach to support the maturation of The
Johns Hopkins Nursing evidence-based practice model through providing leadership, setting expectations,
establishing structure, building skills, and allocating human and material resources as well as incorporating the
model and tools into undergraduate and graduate education at the affiliated university.
Evidence-based practice (EBP) is an essential component of professional nursing,1,2 a crucial
competency for healthcare providers,3 and a basic force in Magnet hospitals4 and results in
better patient outcomes and higher levels of nursing autonomy.5 Fostering EBP within
organizations requires strong infrastructure, including nursing leadership and human and
material resources.6-10 Several organizations have reported on the use of EBP change models to
assist and mentor individual EBP project teams.11-14 One recent publication discusses the use of
a change model in the context of organizational change, highlighting the establishment of an
EBP committee that is positioned within the nursing department’s administrative
structure.15 Approaching the implementation of EBP as an organizational transformational
change frames the approach strategically.16After the creation and testing of a conceptual model
for EBP,17 a strategic plan was developed to implement the Johns Hopkins Nursing EBP model
and guidelines (JHN EBP) throughout the organization. The team knew that the implementation
of EBP would require a substantial change in nursing culture. The goal was to infuse the use of
JHN EBP into routine practice within each department. This goal required a number of strategic
objectives that included developing EBP education programs and Web-based resources,
modifying job description criteria to include behavioral outcomes for EBP, defining the origin of
potential question generation, and building nurse EBP skills and expertise (Table 1). The EBP
program was built through providing leadership, setting expectations, establishing structure,
building skills, and allocating human and material resources. The JHN EBP model and tools
were then incorporated into undergraduate and graduate education at the affiliated university.
This article describes the strategic approach to building infrastructure to support the maturation
of EBP within an academic medical center.
Table 1. Strategic Plan to Infuse The Johns Hopkins Nursing Evidence-Based Practice (EBP)
Model
Leadership
Leadership endorsement was the initial step in building the EBP program. Nurse administrators
are responsible for managing both human and material resources necessary for the successful
implementation of the EBP program. Leadership is critical to build organizational readiness for
change.16,18 This nursing department is part of a highly decentralized organization. A director
of nursing, an administrator, and a physician director lead each department with responsibility
for the service area. Because of their accountability for resources, it was essential that the
directors of nursing were committed to the EBP implementation goals. The strategic plan was
approved by leadership and the governance committees (standards of care [SOC], standards of
practice, nursing clinical quality improvement, staff education, and research committees) and
was then incorporated into the committee structure.
Establishing the Structure
To establish a structure for building and sustaining EBP, a majority of the governance
committees were charged with specific responsibilities. These governance committees include
committee chairs, SOC, standards of practice, nursing clinical quality improvement, staff
education, and research. Committee chairs consist of the chairs and cochairs for each of the
governance committees. Committee chairs drafted EBP committee goals that were aligned with
the purpose of each committee. Each committee then reviewed and revised or supported these
goals. In addition, the purpose and functions of each committee were reviewed in light of the
EBP initiative. During implementation, each committee in the governance structure had
responsibility for a specific goal (Figure 1). The SOC committee became responsible for
reporting progress and monitoring outcomes of the EBP initiatives within each department. This
structure was important because it infused the responsibility for EBP across the professional
governance committees, making nurse leaders on the committees accountable for growing and
sustaining the EBP program. To continue to enhance EBP expertise and engagement, each
department is completing at least 1 project over a 15-month period.
Figure 1
The shared governance role in the implementation of evidence-based practice (EBP).
Developing an EBP Skill Set
One of the most important steps in the plan was to develop EBP experts that would act as future
mentors. These individuals were to be the primary champions and facilitators of EBP. They were
members of the governance committees; thus, incorporating EBP goals into responsibilities as a
committee member was well aligned with moving the strategic initiative ahead.19In addition,
nurse schedules needed to accommodate time away from clinical responsibilities for initial
training and then later to complete the EBP process. The buy-in from nursing leadership was
essential to support nurse scheduling to meet the training requirements, provide the needed
encouragement, and assure that the EBP projects were focused on an important area for which
practice recommendations were needed.
Development of Material Resources
A number of resources needed to be established to foster the growth and development of the
program. These resources included the availability of the JHN EBP model, process, guidelines,
and tools in written and electronic formats. It was also important to assure that library, database,
and Web resources were accessible to each nurse.Training and mentorship were offered in each
department through the committee member mentors who had completed initial training. The
authors (core EBP group) were also available for committee members and teams. Because there
is not one strategy that is always successful, the team planned multiple strategies for training and
education.8 Our goal to develop EBP skills and competencies required that we develop a training
and education plan, using several approaches to meet the needs of the nurses and organization
through multimethod education, demonstration, mentorship, and fellowship. Examples of
strategies included rapid cycle training, a 1-and 2-day seminar approach, multidisciplinary
groups, completion of projects within the committee structure, and committee members
mentoring teams in their departments.In addition to these educational approaches, a fellowship in
EBP was developed and budgeted through the department of nursing administration. Two
fellowships were awarded through a competitive process that provided salary support for 20
hours per week for 3 months. This opportunity provided the time needed for the fellows to
develop advanced EBP skills to prepare them to lead EBP initiatives at the unit, functional unit,
and hospital levels. The first fellow focused on delirium screening and nursing interventions to
decrease the intensity, frequency, and duration of delirium. Results of her project were used to
provide education to unit nurses. She also completed her first publication.20 The team
recommended that the next fellowship be assigned by the SOC committee to better align the
fellow’s work with the needs of the organization. A protocol was selected in the ophthalmology
department, with the second fellow facilitating and supporting their EBP process.An additional
resource developed was EBP assistants who were available on an as-needed basis for unit
projects. These assistants were undergraduate nursing students from local universities. Examples
of the types of support they provided include running literature searches, retrieving requested
articles, disseminating the team’s evidence summaries, and documenting EBP team meetings.
The salary for these assistants was initially supported through a small grant from the Maryland
Health Services Cost Review Commission. After a favorable evaluation of this resource at the
end of the funding period, EBP assistants were included in subsequent nursing administration
budgets.
Setting Expectations
To incorporate EBP as an expectation of nursing practice, nursing staff job descriptions were
revised after significant input from the governance committees, staff, and managers. An example
of a revision is provided in Figure 2. It was important to construct language that was broad
enough to allow different units to apply the standard to fit their needs. All indirect care positions
are now under review for incorporating EBP expectations.
Figure 2
Job descriptions revisions to incorporate evidence-based practice (EBP) into standard: maintains
awareness of scientific basis for nursing practice.A basic Web EBP course was developed in
2005 and implemented as a required competency for RNs in 2006 to promote understanding of
the EBP program, goal, and resources. The basic competency education will move from yearly
competency to the nurse orientation curriculum for 2007. Three additional modules are in
development to address educational needs beyond basic competencies.
Collaborative Strategies: Introduction of the Model to the School of Nursing
Since the early 1990s, research utilization has been a major focus in the undergraduate research
courses at Johns Hopkins University School of Nursing (JHUSON). As the focus changed from
research utilization to EBP and the JHN EBP team began presenting their model and resources,
part of the implementation plan was to infuse EBP into the JHUSON. In fall of 2004, a pilot was
conducted with 1 section of the undergraduate research class. The class used the JHN EBP tools
and worked on a project from a problem identified by nurses at The Johns Hopkins Hospital. The
requirement for an undergraduate EBP project was revised with full implementation using the
JHN EBP model in the spring semester of 2005.At the same time, the master’s program
curriculum was being revised. Revisions were driven by the belief that the research course
should prepare advanced practice nurses to translate evidence into the best practices. A new
course was developed: Application of Research to Practice. The skills demonstrated are essential
for the EBP organizational leader. Two outcomes of this course include (1) conducting a team
EBP project and (2) demonstrating evidence critique and rating competencies in an individual
state of the sciences paper. The focus of these assignments can be clinical, administrative, or
educational nursing problems.Incorporating these changes into the JHUSON curriculum also
required faculty training in the conceptual underpinnings of the model as well as the EBP
process and available tools. Three members of the team presented a faculty training seminar,
covering the model, tools, and process. A mock critique and rating session provided the faculty
with a hands-on experience with the tools and process.
Lessons Learned
The EBP implementation and infusion described in this article occurred between 2004 and 2006.
The team learned a number of lessons, which include the importance of leadership support to
foster the strategic plan, the need for flexibility in training approaches to meet the requirements
of the staff, the necessity of strategic resource planning, the essential role of mentors, and the
need to have a model and tools available. Seeking synergistic opportunities to collaborate with
academic institutions and students provides a win-win outcome.20
Model and Tool Revisions
We have used the model and guidelines previously published21 in multiple projects within and
outside the organization. Based on this experience, we have kept the PET (practice
question, evidence, translation) process in place but have made some modifications to the tools
used for the EBP project (Figure 3) and further refined the graphic for the conceptual model
(Figure 4). Within the JHN EBP model, EBP is a problem-solving approach to making clinical,
educational, and administrative decisions that combines the best available scientific evidence
with the best available practical evidence. The process takes internal and external influences on
practice into consideration and requires the nurse to use critical thinking when applying the
evidence.17
Figure 3
Evidence-based practice tools.
Figure 4
Johns Hopkins Nursing evidence-based practice conceptual model.
Future Directions
The JHN EBP has evolved into a mature phase of development. To move to the next stage, we
need to develop and mentor additional EBP experts, expand the use of the model and tools, and
continue to make revisions based on our experiences. We have planned additional training for
staff and mentors, co
