Friday October 31st 2014

Evidence-based practice: How to change for the better

Marie-Elena Barry

Have you ever heard comments such as, “We’ve always done it this way” or, “Why should we change practice now?” It’s human nature to resist change. We are creatures of habit and tradition. And, although RNs possess advanced skills and education, it can be challenging to have to do things differently, even when the need is plainly in front of our eyes.

Evidence-based practice answers these questions. In the Journal of Nursing Management, nurse researchers Eira Kristiina Hyrkäs, PhD, LicNSc, MNSc, RN, and James P. Rhudy, DNP, APRN, CCRN, CMC-CSC-CCNS, describe evidence-based practice as a clinical practice that systematically reviews current research findings, quality and the evaluation data. As RNs who value evidence-based practice, we acquire information to positively impact patient safety, improve quality and update organizational practice, policies and protocols.

If you’ve wondered how to implement evidence-based practices in your clinical environment to improve patient outcomes, consider using a model to help you implement a practice change. One such model is recommended by Arizona Nurses Association member Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, and Ellen Fineout-Overholt, PhD, RN, FNAP, FAAN, in their 2011 guide, Evidence-based Practice in Nursing & Healthcare: A Guide to Best Practice.

Step 1: Assess the need for change in nursing practice. Ask questions such as “Why do we need to change practice? Is our current practice outdated?”

Step 2: Look for the most recent evidence on the subject of interest. Have there been recent publications that either support or refute current practices? If so, what does the literature suggest?

Step 3: Critically evaluate the literature and analyze the evidence for or against changing practice.

Step 4: Integrate evidence-based practice into a plan and put the change into practice.

Step 5: Evaluate the evidence-based practice change. Was the expected outcome realized?

Case scenario

Alexa, a charge nurse working in an acute rehabilitation stroke unit on night shift for nearly four years, noticed that three of her four patients had fallen during nurse-to-nurse shift report during a two-week period. She thought that this was unusual and discovered that within a 10-day period, seven other patients had fallen during change-of-shift nurse reporting. After consulting with the unit manager, Alexa decided to look into factors that contributed to patient falls during the night on her unit.

By applying steps one through five, Alexa established that the oncoming shift typically listened to a tape-recorded report in a conference room located away from patient rooms, while the off-going shift tidied up loose ends at the nurses’ station. Alexa decided to speak with other nurses on her unit about her concerns regarding the increase in falls during shift changes. She found that her colleagues were also concerned about patient falls, but weren’t certain how to tackle the problem (Step 1). Alexa learned that the stroke unit had experienced a 50 percent increase in falls during an 18-month period. Then Alexa and other concerned nurses formed a task force to examine recent literature that would support a practice change to reduce patient falls. She found recent literature on the hospital’s online health care library that supported bedside change-of-shift reporting (Step 2).

The nurses critically appraised the literature, and came up with suggestions and determined best practices to reduce patient falls. Time and again, the literature review proposed using a hand-off tool at the patient’s bedside during change-of-shift reporting (Step 3). The stroke nurse team brought up the concept of using a standardized tool to the unit manager, who approved a three-month trial period of bedside reporting during shift change (Step 4). The nurses collected fall data during the trial period and found that implementing this new practice, a standardized tool for shift change at the bedside, significantly reduced falls on the stroke unit to less than one-half of the national benchmarked average (Step 5).

Every day, and in every clinical setting, health care providers ask clinical questions to discover answers that improve care. Evidence-based practice is a term that supports safe and quality patient care and is a method for nurses to critically review current practice. In addition, evidence-based practice challenges bedside nurses, nurse managers and the nursing community to implement changes and to conjure interventions leading to quality improvement. RNs can apply evidence-based practices by asking the burning question, “Why do we do it THIS way?”

— Marie-Elena Barry is a senior policy analyst in Nursing Programs at ANA.

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