Laura Cullen

Planning for implementation of evidence-based practice.

Expectations for evidence-based healthcare are growing, yet the most difficult step in the process, implementation, is often left to busy nursing leaders who may be unprepared for the challenge. Selecting from the long list of implementation strategies and knowing when to apply them are a bit of an “art,” matching clinician needs and organizational context. This article describes an application-oriented resource that nursing leaders can use to plan evidence-based practice implementation in complex healthcare systems.

An Advanced Educational Program Promoting Evidence-Based Practice

Evidence-based practice has led to improved health care quality and safety; greater patient, family, and staff satisfaction; and reduced costs. Despite these promising outcomes, use of evidence-based practice is inconsistent. The purpose of this article is to describe an advanced educational program for nurses in leadership roles responsible for guiding teams and mentoring colleagues through the challenges inherent in the evidence-based practice process. The Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice is an innovative program designed to develop advanced skills essential for completing evidence-based practice projects and building organizational capacity for evidence-based practice programs. Learning is facilitated through group discussion, facilitated work time, networking, and consultation. Content includes finding and synthesizing evidence, learning effective strategies for implementation and evaluation, and discussing techniques for building an EBP program in the nurses’ organization. Program evaluations are extremely positive, and the long-term impact is described.

Implementing Preoperative Screening of Undiagnosed Obstructive Sleep Apnea

OBSTRUCTIVE SLEEP APNEA (OSA) is a recent but significant clinical issue reported in the literature only in the last couple of decades. An estimated 12 million Americans, or 2% to 7% of the population are affected by sleep apnea. Reports show that as many as 75% of obese patients experience OSA. Surgical or procedural patients have a reported prevalence of 43% and are at high risk because of the added effects of anesthetic medications.

Iowa Model of Evidence‐Based Practice: Revisions and Validation

Background The Iowa Model is a widely used framework for the implementation of evidence-based practice (EBP). Changes in health care (e.g., emergence of implementation science, emphasis on patient engagement) prompted the re-evaluation, revision, and validation of the model. Methods A systematic multi-step process was used capturing information from the literature and user feedback via an electronic survey and live work groups. The Iowa Model Collaborative critically assessed and synthesized information and recommendations before revising the model. Results Survey participants (n = 431) had requested access to the Model between years 2001 and 2013. Eighty-eight percent (n = 379) of participants reported using the Iowa Model and identified the most problematic steps as: topic priority, critique, pilot, and institute change. Users provided 587 comments with rich contextual rationale and insightful suggestions. The revised model was then evaluated by participants (n = 299) of the 22nd National EBP Conference in 2015. They validated the model as a practical tool for the EBP process across diverse settings. Specific changes in the model are discussed. Conclusion This user driven revision differs from other frameworks in that it links practice changes within the system. Major model changes are expansion of piloting, implementation, patient engagement, and sustaining change. Linking Evidence to Action The Iowa Model-Revised remains an application-oriented guide for the EBP process. Intended users are point of care clinicians who ask questions and seek a systematic, EBP approach to promote excellence in health care.BACKGROUND The Iowa Model is a widely used framework for the implementation of evidence-based practice (EBP). Changes in health care (e.g., emergence of implementation science, emphasis on patient engagement) prompted the re-evaluation, revision, and validation of the model. METHODS A systematic multi-step process was used capturing information from the literature and user feedback via an electronic survey and live work groups. The Iowa Model Collaborative critically assessed and synthesized information and recommendations before revising the model. RESULTS Survey participants (n = 431) had requested access to the Model between years 2001 and 2013. Eighty-eight percent (n = 379) of participants reported using the Iowa Model and identified the most problematic steps as: topic priority, critique, pilot, and institute change. Users provided 587 comments with rich contextual rationale and insightful suggestions. The revised model was then evaluated by participants (n = 299) of the 22nd National EBP Conference in 2015. They validated the model as a practical tool for the EBP process across diverse settings. Specific changes in the model are discussed. CONCLUSION This user driven revision differs from other frameworks in that it links practice changes within the system. Major model changes are expansion of piloting, implementation, patient engagement, and sustaining change. LINKING EVIDENCE TO ACTION The Iowa Model-Revised remains an application-oriented guide for the EBP process. Intended users are point of care clinicians who ask questions and seek a systematic, EBP approach to promote excellence in health care.

An evidence-based practice model.

THE EVIDENCE-BASED PRACTICE (EBP) process is fraught with challenges for clinicians trying to create systematic changes to improve quality and safety in health care. Early research described the EBP process and the barriers that occur when using the process in practice. More recent work is designed to overcome some of these identified barriers or challenges. A number of models outlining steps in the process have been developed to assist clinicians when leading EBP changes. It is recommended that each organization choose a model to guide use of EBP. Become familiar with the EBP model used in your health care or specialty organization. We will review one model to illustrate the steps in the EBP process.

What Is Evidence-Based Practice?

Local, national, and international efforts have led to important developments in evidence-based practice and delivery of evidence-based health care. In this column, we plan to share information that will support adoption of EBP to improve outcomes for patients, families, clinicians, and organizations. Our goal is to share current developments soreaderscangainadditionalknowledgeandskillstoapply EBP principles. Thisfirst column will describe the linkages and differences between EBP and related terms. Watch for information describing the EBP process and application in perianesthesia nursing in upcoming columns. What is evidence-based practice? The term evidencebased practice comes from a movement in the United Kingdom that occurred during the same time US nurses werefocusingon research utilization. Research utilization is the application of research findings in practice. EBP uses research findings but incorporates additional concepts. Evidence-based nursing is defined by Sigma Theta Tau International as ‘‘. the process of shared decisionmaking between practitioner, patient, and others significant to them, based on research evidence, the patient’s experiences and preferences, clinical expertise or knowhow, and other available robust sources of information.’’ 1 Many others have shared similar definitions based on Sackett et al’s work, defining EBP as health care delivery based on the integration of the best research evidence available combined with clinical expertise, in accordance with the preferences of the patient and family. 2,3

Evidence Into Practice: Integration Within an Organizational Infrastructure

OPERATIONALIZING A SHARED GOVERNANCE structure creates important improvements in professional practice. Having a shared governance structure is certainly not new; the University of Iowa Hospitals and Clinics has had nursing shared governance since 1975. Effective governance structures are essential for clinicianled organizational improvements and are key to structural empowerment. Building evidencebased practice (EBP) into a governance structure is one strategy for promoting an organizational culture valuing and expecting evidence-based care.

Restructuring the clinical nurse specialist position to a unit-based role.

Role restructuring can be the key to maximizing efficiency, productivity, and operational effectiveness. The clinical nurse specialist role was restructured from a divisional project focus to a unit-based design to enhance the care of specific patient populations. The authors describe the process used to make this change, the outcomes achieved, and the lessons learned.

Usability Evaluation and Implementation of a Health Information Technology Dashboard of Evidence-Based Quality Indicators

Health information technology dashboards that integrate evidence-based quality indicators can efficiently and accurately display patient risk information to promote early intervention and improve overall quality of patient care. We describe the process of developing, evaluating, and implementing a dashboard designed to promote quality care through display of evidence-based quality indicators within an electronic health record. Clinician feedback was sought throughout the process. Usability evaluations were provided by three nurse pairs and one physician from medical-surgical areas. Task completion times, error rates, and ratings of system usability were collected to compare the use of quality indicators displayed on the dashboard to the indicators displayed in a conventional electronic health record across eight experimental scenarios. Participants rated the dashboard as “highly usable” following System Usability Scale (mean, 87.5 [SD, 9.6]) and Poststudy System Usability Questionnaire (mean, 1.7 [SD, 0.5]) criteria. Use of the dashboard led to reduced task completion times and error rates in comparison to the conventional electronic health record for quality indicator–related tasks. Clinician responses to the dashboard display capabilities were positive, and a multifaceted implementation plan has been used. Results suggest application of the dashboard in the care environment may lead to improved patient care.

Evidence Into Practice: Leading New Graduate Nurses to Evidence-Based Practice Through a Nurse Residency Program

Janet Hosking, MSN, RN-BC, Nursing Practice Leader, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA; Katie Knox, MSN, RN-BC, Lecturer, University of Iowa College of Nursing, Iowa City, IA; Jeana Forman, MSN, RNC, Nursing Practice Leader, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA; Lou Ann Montgomery, PhD, RN-BC, Director, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA; Jill Gaffney Valde, PhD, RN, Associate Professor, Clinical, University of Iowa College of Nursing, Iowa City, IA; and Laura Cullen, DNP, RN, FAAN, is an Evidence-Based Practice Scientist, Office of Nursing Research, Evidence-Based Practice and Quality, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA. Conflict of interest: None to report. Address correspondence to Laura Cullen, Office of Nursing Research, Evidence-Based Practice and Quality, Department of Nursing Services and Patient Care Services, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242; e-mail address: laura-cullen@uiowa.edu. 2016 by American Society of PeriAnesthesia Nurses 1089-9472/