Involving the Faculty in Integration of Evidence Based Practice into the Curriculum GANE 2009 Cheryl M. Smith RN, EdD Sheri Noviello RN, PhD June Goyne RN, EdD

Program Objectives Discuss evidence-based practice (EBP) in nursing Understand how healthcare workers and providers can integrate EBP principles into practice Explain how nursing programs can implement EBP into the curriculum Discuss the strategies used by CSU Dept. of Nursing to implement EBP into the curriculum

Evidence-Based Practice (EBP) What is it? –Basically, it is an approach that enables clinicians to provide the highest quality of care in meeting the multifaceted needs of their patients and families. Melnyk, B. & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare. Philadelphia: Lippincott.

EBP Conscientious use of current best evidence in making decisions about patient care Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W., & Haynes, R.B. (2000). Evidence- based medicine: How to practice and teach EBM. London: Churchill Livingstone.

Principles of EBP A problem-solving approach to clinical practice that integrates A systematic search for and critical appraisal of the most relevant evidence to answer a burning clinical question One’ own clinical expertise Patient preferences and values Melnyk, B. & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare. Philadelphia: Lippincott.

NOT Research Utilization Research utilization is typically using one research study to guide the development or revision or policies and/or procedures EBP uses the best evidence along with the nurse’s expertise and the patient’s preferences and values

Why Incorporate EBP? If your child was in an accident and sustained a severe head injury, would you want to know that the most effective, empirically supported treatment established from randomized controlled trials was being used to decrease his or her intracranial pressure?

Why Incorporate EBP? If you were on a ventilator in the ICU, would you want your nurse to be equipped with the best evidence before squirting saline down your ETT for suctioning? And would you also want that same nurse to have the best evidence to prevent ventilator acquired pneumonia before caring for you?

What About Your New Graduate’s Practice? Are you preparing your graduates to practice in tradition or with EBP? Will you be comforted or will you experience worry when one of your graduates introduces themselves as “your nurse for the day”?

Why Incorporate EBP? Improved patient outcomes!! –28% improved outcomes Heater, B., Becker, A., & Olson, R. (1988). Nursing interventions and patient outcomes: A meta-analysis of studies. Nursing Research, 37, Nurses who use EBP experience higher levels of satisfaction than those who deliver based on tradition Dawes, M. (1996). On the need for evidence-based general and family practice. Evidence-Based Medicine, 1,

Evidence shows that the evidence works!!! Now, how do we integrate EBP into the BSN curriculum?

Faculty Buy-In ???

Faculty Buy-In: Keys to Success ☺Administration Active Support ☺Faculty Education ☺Involve All Levels ☺Patience – Gradual Process

Administration Support “Walks the Walk” –Becomes Knowledgeable – $$$ –Patience “Talks the Talk” –Values EBP –Use the Vocabulary (VISIBILITY) –Encouraging to Faculty

Faculty Buy-In TRY IT! VISIONARIES: Get Ahead PRAGMATISTS: Stick with the herd CONSERVATIVES: Hold On SKEPTICS: No Way 16%50%84%

Faculty Education Early Adopters & Visionaries 1st –Send to conferences –Sponsor local conferences –Articles / Books –Contact experts (phone, )

EBP Resources Center for the Advancement of Evidence- Based Practice (Arizona State University) Academic Center for Evidence Based Practice (University Texas Health Science Center, San Antonio) The Indiana Center for Evidence-Based Nursing Practice (Purdue University Calumet's School of Nursing) GROWING ….

Center for the Advancement of Evidence- Based Practice (Arizona State University) Nurse Educator EBP Mentorship Program © Held Every Year in July, Phoenix, AZ The Nurse Educator EBP Mentorship Program is intended for all levels of nurse educators in schools of nursing. This is a 4-day immersion program, held on the ASU College of Nursing & Healthcare Innovation Downtown Phoenix campus, designed to prepare faculty to integrate EBP across their nursing curricula. Participants will have didactic and interactive experiences teaching EBP and mentoring others to teach the EBP paradigm and process.Nurse Educator EBP Mentorship Program Fee: $ or more $1750 each

Faculty Education Support Pragmatists –Hold in-house workshop –Share materials –Send to workshops – look for regional events –SUPPORT when trying it out

Faculty Buy-In Support Conservatives EVEN MORE –Work with knowledgeable person –Share materials –Send to workshops –SUPPORT, SUPPORT when trying it out

Faculty Buy-In Skeptics –Encourage –SUPPORT, SUPPORT, SUPPORT when trying it out –Know when to STOP

Integration Junior level –Introduce EBP –Introduce PICO questions Senior level –Use EBP in clinical areas –EBP in research course –Apply EBP

Definition of a PICO question A standardized format for asking a clinical question

P Patient/ Population What is the primary problem, disease or co-existing conditions? On what groups do you want information? How would you describe a group of patients similar to the one in question? Sometimes age, sex or ethnicity of a patient may be relevant. I Intervention What medical event do you want to study the effect of? Which main intervention are you considering, prescribing a drug, ordering a test, ordering surgery C Comparison ( optional to use because you may not want to look at an alternative ) Compared to what? Better or worse than no intervention at all or than another intervention? What is the main alternative to compare with the intervention, are you trying to decide between two drugs, a drug and a placebo, or two diagnostic tests O Outcome What is the effect of the intervention? What do you hope to accomplish, measure, improve, or affect with this intervention? What are you trying to do for the patient, relieve or eliminate the symptoms, reduce side effects, reduce cost…

Example of a PICO question P ( Patient/population ) Patients with Tetracycline staining I (Intervention) Chair side (Zoom) bleaching C ( Comparison ) Over the counter white strips O (Outcome) Decrease staining and increase tooth whiteness

Scenario: In a 4 year old boy requiring antibiotics, do probiotics (dietary supplements containing potentially beneficial bacteria or yeasts) decrease the risk of developing antibiotic associated diarrhea? P4 year old male on antibiotics IProbiotics CNone/placebo ODecrease the risk of antibiotic associated diarrhea

The CSU PICO plan for junior nursing students Junior Year, Fall Semester: The student recognizes a PICO question bases on a given scenario searches the PICO question given in class submits the title page, PICO search “snap shot”, and one reference (APA) format Junior Year, Spring Semester: The student will translate the clinical question(s) into a searchable question using PICO perform a literature search in the appropriate source(s) report to the clinical group their findings and how it relates to their patient's

The CSU PICO plan for senior nursing students Senior year, fall semester: The student will retain the knowledge from the previous year and build on search techniques identify the category of the PICO question select the best study design needed to answer the PICO question develop practice guidelines and present to the hospital staff Senior year, spring semester: The student will develop PICO searches in clinical apply EBP in his/her practice critically appraise or formally evaluate for validity and usefulness

Conclusion It’s evolving –Sometimes it works and sometimes it doesn’t It’s a work in progress Changes each semester More faculty on board Questions?????

Thanks for your attention!!

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References Dawes, M. (1996). On the need for evidence-based general and family practice. Evidence-Based Medicine, 1, Heater, B., Becker, A., & Olson, R. (1988). Nursing interventions and patient outcomes: A meta-analysis of studies. Nursing Research, 37, Melnyk, B. & Fineout-Overholt, E. (2005). Evidence-based practice in nursing & healthcare. Philadelphia: Lippincott. Sackett, D.L., Straus, S.E., Richardson, W.S., Rosenberg, W., & Haynes, R.B. (2000). Evidence-based medicine: How to practice and teach EBM. London: Churchill Livingstone.