Enhancing Knowledge About Evidence-Based Practice Using Nursing Grand Rounds Jennifer Kitchens, MSN, ACNS-BC, CVRN, RN Bonnie Kruszka, DNP, MSN, CPN, FNP, NP-C, ENP-BC, RN Margie Hull, M.Ed., MSN, ACNS-BC, CDE, RN Lenora Maze, MSN, CNRN, RN

Purpose To implement and evaluate evidence-based practice (EBP) nursing Grand Rounds as a clinical education strategy to address nurses’learning needs

Significance Implementation of EBP into nursing clinical practice has been shown to improve patient outcomes Delivery of care based on nursing expertise, patient preference & best available evidence (research) Current research highlights the struggle experienced by RNs to use and implement research findings in clinical practice Online learning methods have been adopted by many healthcare facilities Needs assessments identified that nurses preferred interactive learning for some content Examined ways to translate concepts to the daily practice of nursing Other disciplines have used grand rounds as a teaching method to promote interaction and engagement

Background Several interventions already implemented to advance EBP knowledge Implemented Strategies: Formulation of a EBP/Research Council with a “burning question link” Administration and evaluation of Academic Center for EBP Evidence-Based Practice Readiness Inventory Report Development of electronic online learning modules Journal Clubs Critical appraisals of topics Facility needs assessments identified preference for interactive learning with some content Needs assessments identified that nurses preferred interactive learning with some content (especially with unfamiliar content and abstract concepts)

Implement practice change Iowa Model of EBP Ask clinical question Search the literature Appraise evidence Implement practice change Evaluate Used adaptation of the Iowa model as a conceptual framework for development of program Ask the clinical question: Are nursing grand rounds an effective teaching method that engages the audience and promotes participation interaction? Literature search: effectiveness in medical discipline, little attention in the nursing literature Appraise evidence: effective teaching method in residency programs and community hospitals Implemented practice change: developed ebp grand rounds Evaluated effectiveness: results were favorable (Titler et al., 2001)

Background (Cont.) Examined additional ways to translate EBP concepts to daily practice of nursing Effectiveness, processes and outcomes in nursing Grand Rounds received little attention in the literature However, other disciplines have used Grand Rounds as an effective teaching method to promote interaction and engagement

Objectives of EBP Grand Rounds Describe the use of evidence-based practice as an important process needed for quality care and optimal patient outcomes including: Sources of evidence Definition of EBP EBP process and clinical nursing examples List resources to find and evaluate evidence to support nursing practice with limited resources, time, and experience including searching for evidence and subject-specific databases Case example EBP project

Implementation Prioritizing and integrating topics Developing an EBP presentation Coordinating nursing contact hour process Designing handouts Advertising Acquiring media technology Cultivating a learning environment Engaging participation Analyzing evaluation data Disseminating findings

Evaluation Meeting program objectives, methods and presenter effectiveness A pre- and post EBP readiness survey was administered A 5-point Likert scale was used to score meeting program objectives, methods and presenter effectiveness and the EBP survey Scores: 1 being most negative and 5 being most positive

Outcomes There were 8 duplicate nursing Grand Rounds sessions offered at various times/locations (0.5 nursing contact hour each) Total attendance = 46 nurses The mean evaluation scores were positive: meeting program objectives 4.53; methods effectiveness 4.76; presenter effectiveness 4.81

EBP Survey Results Survey Item Pre Mean Post Mean 4.68 4.98 4.62 4.91 Important to share ideas with colleagues 4.68 4.98 Importance of EBP to practice 4.62 4.91 Aware of sources of health care information 3.47 4.37 Comfort level in using EBP 3.64 Ability to identify clinical problem/EBP question 3.45 4.24

Interpretation The EBP nursing Grand Rounds was an effective clinical education strategy to address the learning needs of nurses

Implications Use Grand Rounds as an additional method to educate nurses Evaluation of nursing EBP adoption Dissemination of findings

References Agee, N., Komenaka, I.K, Drachman, D., Bouton, M.E., Caruso, D.M., & Foster, K.N. (2009). The effectiveness of grand rounds lectures in a community-based hospital. Journal of Surgical Education, 66(6), 361-366. doi: 10.1016/j.surg.2009.07.006. Armola, R., Brandeburg, J., & Tucker, D. (2010). A guide to developing nursing grand rounds. Critical Care Nurse, 30(5), 55-62. doi: 10.4037/ccn2010486. Bohman, D.M., Ericsson, T., Borglin, G. (2012). Swedish nurses’ perception of nursing research and its implementation in clinical practice: a focus group study. Scandinavian Journal of Caring Sciences. Advance online publication. doi: DOI: 10.1111/j.1471-6712.2012.01058. Mjid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chnag, Y., Mokhtar, I. (2011). Adopting evidence- based practice in clinical decision making: nurses’perceptions, knowledge, and barriers. Journal of the Medical Library Association, 99(3), 229-236. Myint, P.K., & Sabanathan K. (2005). Role of grand rounds in the education of hospital doctors. Hospital Medicine, 66, 297-299. Richmond, D.E. (1985). The educational value of grand rounds. New Zealand Medical Journal, 98, 280-282. Schmidt, N.A. & Brown, J. M. (2014).  Evidence Based Practice for Nurses: Appraisal & Application (3rd ed.).   Boston, MA: Jones & Bartlett Learning.

Q & A

Contact Information Jennifer Kitchens Margie Hull Clinical Nurse Specialist Acuity Adaptable Diabetes Clinical Nurse Specialist, CDE jennifer.kitchens@eskenazihealth.edu margie.hull@eskenazihealth.edu Bonnie Kruszka Lenora Maze Family Nurse Practitioner Clinical Nurse Specialist, Critical Care & Neuroscience bonnie.kruszka@eskenazihealth.edu lenora.maze@eskenazihealth.edu Marian University Adjunct Faculty bkruszka@marian.edu