Applying Evidence Based Practice
Applying Evidence Based Practice
When thinking of evidence-based practice (EBP), research, and research utilization, it is imperative to realize that each of these concepts go hand in hand. Beginning with research, it is the gathering and analyzation of data that is used to formulate ideas and theories (Parahoo, 2014). The genesis of research typically begins with identifying an area in which there is a shortfall of knowledge that can benefit from the development of a theory, in order to close that gap.
Research utilization and EBP are closely related. Research utilization involves implementing research in one form or another into practice; there are three types: instrumental utilization —which entails the application of knowledge into practice; conceptual utilization —involves a shift in the way one thinks, but not a specific behavior; and persuasive utilization —persuading others using obtained knowledge to change their “predetermined position” (Parahoo, 2014, p.394.
According to Parahoo (2014), EBP is an instrumental form of research utilization and is defined as the “direct use of research in one’s practice” (p. 394); this begins with clinical inquiry, with a focus on practice related questions, resulting in using the evidence gathered in practice.
Evidence Based Practice Steps
At the Saint Louise Regional Hospital med-surg unit, there have been instances where patients have fallen during change of shift and hand-off reports. Hand offs usually occur at the nurse’s station or in the hallways. In one instance, a patient was calling to use the restroom. No nurses were available to respond, and the patient resorted to getting out of bed to use the restroom. During the process of making her way to the restroom, the patient experienced a fall that resulted in a fractured hip. If rounds had been conducted during the change of shift and hand off, this situation could have potentially been avoided.
This unfortunate event placed the entire department, including myself, in a state of concern because it brought to the forefront the paramount issue of safety and quality patient care. This event caused me to explore the possibility of a bedside shift report. While perusing articles, I stumbled across one that outlined the vitalness of a bedside shift report in terms of increasing patient safety. The research demonstrated the bedside shift reports are instrumental in providing patient centered care; it allows effective communication, patient involvement in their plan of care, and the ability to be there for the patient if any need should arise (Hull and Zheng, 2018).
Before delving into the steps of EBP, we should consider having a step zero, which involves “cultivating a spirit of inquiry along with an EBP culture” (Melnyk et al., 2014). Melnyk and her colleagues (2014) argue that without the cultivation of a spirit of inquiry, the clinician will not effectively ask clinical questions about their practices.
The first step of the EBP calls for the creation of a Population, Intervention, Comparison, Outcome, and Time (PICOT) clinical inquiry which will serve as a map in obtaining the most optimal evidence that supports the use of a bedside shift report. In Saint Louise Regional Hospital’s case, do the nurses in the med-surg unit benefit from using a bedside shift report when compared to conducting handoffs in the hallways or nurses’ station? Is there an improvement in the quality of care being given using the bedside shift report during a three-month period?
The second part of the EBP involves utilizing the PICOT to search for evidence from databases such as MEDLINE, PubMed, and CINHAL. The research will focus on the following key terms: patient centered care, bedside care, bedside report, handoffs, patient focused care, and patient involvement.
The third portion of the EBP will focus on appraising the collected data and critically analyzing it to discover which of the articles are the most applicable to our med-surg department as well as the validity and reliability of the resources. The evidence gathered will be analyzed according to the principles set by Kader Parahoo. When reading a study, Parahoo (2014) recommends that we uncover the “actions and decisions” (p. 385) the researcher made, and the logic behind them to determine the influences of the data collected.
The fourth step involves bringing together the acquired evidence that held both clinical expertise and patient preferences and values. The fifth steps calls on the implementation of the bedside shift report created by the research and evidence. The steps used to implement the bedside shift report, set by the U.S. Department of Health, include: first forming a multidisciplinary team to identify areas of improvement; then, deciding on how to implement the strategy —including logistics, what tools will be used, and what training should be conducted (U.S. Department of Health, 2013).
The last step is evaluating the bedside report. By getting feedback from nurses, as well as patients and their families, we can evaluate how the bedside shift report has improved the quality of care, what worked and didn’t work well, and how the process can be changed in order for it to be successful; the feedback can be obtained by focus groups, patient and family satisfaction surveys, and staff surveys (U.S. Department of Health, 2013).
By fine tuning the beside shift report, not only can we avoid tragic situations such as a patient fracturing their hip —or even worse, we can also improve the quality of care by making the health care we provide patient centered.
Hull, R., & Zheng, M. L. (2018). Improving Patients’ Quality of Care through Bedside
Shift Report. Penn State Hershey Nursing. Retrieved October 28, 2018.
Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The
Establishment of Evidence-Based Practice Competencies for Practicing
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Parahoo, K. (2014). Nursing research: Principles, process and issues (3rd ed.). New York, NY: Palgrave Macmillan.
United States Department of Health (2013) Nurse Bedside Shift Report Implementation