1. Clinical Science Investigator’s Toolkit: An Evidence Based Practice Resource for the Bedside Nurse Beth Lacoste RN, APRN, CNS, MSN, CCRN Nicole Jones RN-BC, APRN, CNS-BC, MN, CCRN, CCNS Clinical Nurse Specialists, Critical Care Division East Jefferson General Hospital

2. The presenters have no financial or commercial conflicts of interest to disclose.

3. Objective: At the end of this presentation, the participant will be able to: Describe the development and implementation of a toolkit to engage bedside nurses in applying a model for EBP.

4. Evidence Based Practice What we had in place at EJGH: Research Committee EBP Model EBP initiatives ongoing (quality improvement focused) Center for Nursing Knowledge and Research Doctoral prepared Nurse Researcher

5. ANCC Magnet re-designation survey 2006 Surveyor feedback: –It was evident that our practice was based on research, however, many staff nurses could not clearly articulate their involvement in EBP initiatives

6. With this valuable feedback our magnet journey continues.

7. Follow-up Center for Nursing Knowledge and Research Nurse Researcher presented Unit-based introduction to EBP throughout the organization Staff nurses were encouraged to initiate unit- based clinical inquiry Projects Focus on staff level implementation of our existing EBP model

8. CNS Assessment of Staff Nurse Readiness: What was needed was a practical tool to guide the staff nurse in the process of changing or confirming current practice based on evidence.

9. CNS Action: The CSI toolkit was developed as a step- by-step guide to applying the EBP model.

10. EBP Toolkit Intended for use by nurses with varied educational preparation Serves to link the nurse with appropriate experts Workbook that provides practical tips for how and when to consult the nurse researcher, Advanced Practice Nurse, Librarian and leadership resources during the investigation Serves as a template for systematic documentation so that the findings and outcome of the process can be shared

11. Steps 1 and 2: Identify a Clinical Question and Clarification/Prioritization Identifying a clinical problem –Record background, event, or data that led to this issue Clarifying it in the form of a focused clinical question Identifying other clinicians/leaders who may already be asking the same question

12. Step 2: Engage Stakeholders Calling all Detectives…..

13. Step 3: Evidence Review First: Institutional Evidence –Search hospital intranet site for current policy/ procedure/ protocol Second: Evidence-Based Practice Guidelines –Clinical Guidelines Internet search www.guidelines.govwww.guidelines.gov Professional organization links on hospital intranet Third: Research Literature –EBSCO, Ovid resources

14. “People” EJGH Resources for Searching: –Hospital Librarian –Nurse Researcher (Dr. Bihm x 4854) –Clinical Educators (Center for Nursing Knowledge and Research x 4279) –Clinical Nurse Specialists in your area Step 3: Evidence Review Research / Literature

15. Step 4: Evidence Synthesis Do we have GOOD EVIDENCE to answer our clinical question? No Yes Is the evidence applicable to your patient population and practice setting? NoYes Do we need a practice change? 1.See EBP Model 2.Consult Nurse Researcher 3.Discuss Findings 4.Consider Research No Yes Report Your Findings- Inform Go to Step VII Planning Practice Change Go to Step V

16. Levels of Evidence Comprehensive unbiased analysis using a strict scientific design to assess related studies Scholarly analysis of a body of research about a specific issue or topic Research studies in which treatment and control groups are randomly assigned “gold standard of experimental design” Research studies where a design other than random sampling is used. Merged statistical results from a number of related studies Systematically developed statements by a group of experts to assist practitioner decisions

17. Meet with your leadership –How do we go about implementing this evidence into our hospital practice? –Should we: Change an existing policy? Create a new policy? Purchase new equipment? Do staff education? –Resource: Planning Practice Change Worksheet Step 5: Planning Practice Change

18. Step 6: Implement and Evaluate EBP Change Record pertinent info about: –How and when you made the change –Any outcomes you might have measured following the change –Overall outcome of the change

19. Step 7: Inform and Integrate into Practice Standards Make a poster to share the results of your investigation Bring suggestions for policy changes to the appropriate Shared Governance Council Bring your toolkit to the Center for Nursing Knowledge and Research – a copy will be made as a lasting resource

20. Encouraged staff to: Be Creative Share your CSI Journey Convince others that the change is based on good evidence! Help others bridge the gap between research and practice. Consider presenting findings at a local or national conference.

21. CSI-EJ (Clinical Science Investigation)

22. Objectives At the end of today, you will be able to: 1.Apply the EJGH EBP Model in clinical practice. 2. Gain skills to effectively search scientific literature using EJGH online resources. 3. Evaluate literature for strength of evidence and applicability to practice.

23. Journal Club Title Date and Publication Purpose Setting Population Were the methods used logical and well carried out? Was the study well designed? Do you think the author’s conclusions are valid? How does this study relate to your clinical population? Step 3 – Evidence Review Evidence Critique

24. EBP Detective Training Workshop Outcomes Over 60 interdisciplinary team members attended Identified areas for further education Research Critique class offered – staff nurses and leadership attended Statistics class planned for the future

25. Toolkit Evaluation Many units have completed Clinical Science Investigations using the toolkit EBP Day conducted to share results –Staff posters and completed toolkits Toolkit presented at National Magnet and Critical Care Nurses Conferences Ongoing use of the toolkit allows us to refine the toolkit as a resource to engage the bedside nurse in application of the EJGH EBP model.