Marjorie A. Schaffer

Evidence‐based practice models for organizational change: overview and practical applications

Aim To provide an overview, summary of key features and evaluation of usefulness of six evidence-based practice models frequently discussed in the literature. Background The variety of evidence-based practice models and frameworks, complex terminology and organizational culture challenges nurses in selecting the model that best fits their practice setting. Data sources The authors: (1) initially identified models described in a predominant nursing text; (2) searched the literature through CINAHL from 1998 to current year, using combinations of ‘evidence’, ‘evidence-based practice’, ‘models’, ‘nursing’ and ‘research’; (3) refined the list of selected models based on the initial literature review; and (4) conducted a second search of the literature on the selected models for all available years to locate both historical and recent articles on their use in nursing practice. Discussion Authors described model key features and provided an evaluation of model usefulness based on specific criteria, which focused on facilitating the evidence-based practice process and guiding practice change. Implications for nursing The evaluation of model usefulness can be used to determine the best fit of the models to the practice setting. Conclusion The Johns Hopkins Model and the Academic Center for Evidence-Based Practice Star Model emphasize the processes of finding and evaluating evidence that is likely to appeal to nursing educators. Organizations may prefer the Promoting Action on Research Implementation in Health Services Framework, Advancing Research and Clinical Practice Through Close Collaboration, or Iowa models for their emphasis on team decision-making. An evidence-based practice model that is clear to the clinician and fits the organization will guide a systematic approach to evidence review and practice change.

Assessment, program planning, and evaluation in population-based public health practice.

Public health practitioners in Minnesota developed and implemented a population-based public health practice model for community assessment, program planning, and evaluation. The ultimate goal of this process is improvement in population health. Major challenges to the implementation of a population-based model are addressed through the use of a theory of action; interventions at community, systems, and individual levels; and intermediate evaluation indicators. Examples of resulting changes in public health practice are described.

the Development, Implementation, and Evaluation of an End-of-life Simulation Experience for Baccalaureate Nursing Students

AIM This article presents an example of a high‐fidelity end‐of‐life simulation developed for an elective course in a baccalaureate nursing program. BACKGROUND Nursing education programs often lack opportunities for palliative care experiences in undergraduate education. Simulation offers an alternative learning strategy for nursing students to apply principles of palliative care and communication in a safe, interactive learning environment. METHOD An end‐of‐life simulation for senior nursing students was developed, implemented, and evaluated. Following participation in the simulation, students evaluated educational practices and their satisfaction and confidence in learning. They also completed reflection papers on their learning. RESULTS Student means for items on educational practices and satisfaction and confidence in learning were all between agree and strongly agree on a 5‐point scale of agreement (n = 21). CONCLUSION The end‐of‐life simulation experience created an opportunity for nursing students to gain confidence in their ability to provide palliative nursing care.

Finding Common Ground in Public Health Nursing Education and Practice

Preparation of the public health nursing (PHN) workforce requires public health nurses from academia and practice to collaborate. However, a shortage of PHN clinical sites may lead to competition between schools of nursing for student placements. The Henry Street Consortium, a group of 5 baccalaureate schools of nursing and 13 local health departments in the state of Minnesota, developed a model for collaboration between PHN education and practice. This paper describes the development process--the forming, storming, norming, and performing stages--experienced by the Henry Street Consortium members. The consortium developed a set of entry-level core PHN competencies that are utilized by both education and practice. It developed menus of learning opportunities that were used to design population-based PHN clinical experiences. In addition, the consortium created a model for training and sustaining a preceptor network. The members of the Henry Street Consortium collaborated rather than competed, used consensus for decision making, and respected and accepted different points of view. This collaboration significantly impacted how schools of nursing and local health departments work together. The consortiums ability to retain its relevance, energy, and momentum for both academic and agency partners sustains the collaboration.

A university and health care organization partnership to prepare nurses for evidence-based practice.

This article describes a partnership model between a university and health care organizations for teaching graduate nursing research from a framework of evidence-based practice. Nurses from health care organizations identified topics for graduate students to search the literature and synthesize evidence for guiding nursing practice. Nurse educators mentored graduate students in conducting critical appraisals of the literature. Students learned how to search for the evidence, summarize the existing research findings, and translate the findings into practice recommendations. Through presenting and discussing their findings with key stakeholders, students learned how nurses planned to integrate the evidence into practice. Nurses used the evidence-based results to improve their practice in the two partner hospitals. The partnership stimulated action for further inquiry into best practices.

Ethical Problems Experienced by School Nurses

This study explored school nurses’ experience of ethical conflict in school nursing through interviews with six school nurses. The study examined how school nurses resolved ethical problems and the rationale used to resolve them. Emergent themes of ethical problems were professional relationship conflicts, delegation to and supervision of health assistants, child protection reporting, maintaining confidentiality, Do Not Resuscitate policy, and pressure to work outside of nursing practice standards. School nurses did not use ethical decision-making models in resolving conflict but demonstrated the use of professional standards, ethical principles, and personal values as rationale to resolve ethical problems. Results of this study suggested that school nurses would benefit from additional knowledge about ethical decision-making models. School nurses would also profit from hearing each other’s voices through dialogue about ethical problems and decision making.

A Virtue Ethics Guide to Best Practices for Community-Based Participatory Research

Background: Rule ethics, or principled thinking, is important in the analysis of risks and benefits of research and informed consent, but is not completely adequate for guiding ethical responses to communities as research participants and collaborators. Virtue ethics theory can be used to guide actions in relationships, which are foundational to the implementation of community-based participatory research (CBPR). Virtues are strengths of character that contribute to a life of flourishing or well-being for individuals and communities. Objectives: This article provides an overview of virtue ethics theory, identifies common ethical problems in CBPR, and discusses how professional virtues can be used to guide ethical research practice. Methods: The virtues of compassion, courage, honesty, humility, justice, and practical reasoning are defined and applied to ethical practice in the development, implementation, and dissemination of CBPR. Best practices for CBPR that consider the well-being of communities are identified. Conclusions: The virtues of compassion and humility foster inclusiveness and integration of community perspectives in research collaboration. Courage requires researchers to step out of the research safety-net to listen to community member voices and wisdom and share power in research decisions. Honesty requires researchers to communicate realistic expectations for research outcomes, share all findings with the community, and consider community perspectives in research dissemination. Systematic involvement of the community in all steps of the research process represents the virtue of practical reasoning. From a justice perspective, CBPR aims to restore communities rather than take from them.

The Henry Street Consortium Population-Based Competencies for Educating Public Health Nursing Students

The Henry Street Consortium, a collaboration of nurse educators from universities and colleges and public health nurses (PHNs) from government, school, and community agencies, developed 11 population-based competencies for educating nursing students and the novice PHN. Although many organizations have developed competency lists for experts, the Consortium developed a set of competencies that clearly define expectations for the beginning PHN. The competencies are utilized by both education and practice. They guide nurse educators and PHNs in the creation of learning experiences that develop population-based knowledge and skills for baccalaureate nursing students. Public health nursing leaders use the competencies to frame their expectations and orientations for nurses who are new to public health nursing. This paper explains the meaning of each of the 11 population-based competencies and provides examples of student projects that demonstrate competency development. Strategies are suggested for nurse educators and PHNs to promote effective population-based student projects in public health agencies.

A comparison of the Well Child Clinic services in Norway and the Nurse Family Partnership programme in the United States

AIM AND OBJECTIVES To present a comparison and a discussion of the Well Child Clinic model in Norway and the Nurse-Family Partnership model in the United States. BACKGROUND The Nurse Family Partnership programme in the United States is voluntary and not universal. The Well Child Clinic programme in Norway is voluntary but universally available for Norwegian families. As the Well Child Clinics are used by the vast majority of the families in Norway, it is difficult to determine the benefits and outcomes for the families who receive universal services. DESIGN Qualitative design. METHODS Authors reviewed the literature on the Norwegian Well Child Clinics and the Nurse Family Partnership programme in the United States and interviewed public health nurses experts on evidence-based home visiting programmes in Minnesota. RESULTS The similarities between goals and content of the Nurse Family Partnership programme in the United States and the Well Child Clinic services in Norway are emphases on (1) intensive services, (2) a focus on behaviour, (3) the inclusion of both parents and children and (4) programme fidelity. The major difference in the programmes is the focus on a targeted population for the Nurse Family Partnership programme vs. the universal offer of Well Child Clinics in Norway. CONCLUSION Norway should continue with universal approach to support new families. A model similar to Nurse Family Partnership could be developed in Norway as an addition to the existing universal services, as an offer to the high-risk families. RELEVANCE TO CLINICAL PRACTICE Public health nursing leaders in Norway need to advocate for public health nurse ratios that make it possible for public health nurses to follow government guidelines. A model similar to Nurse Family Partnership could be developed in Norway as an addition to the existing universal services, as an offer to the high-risk families.

Evidenced-based guidelines for public health nursing practice

Abstract Practice guidelines that provide research-based information for practice and promote improved health outcomes are needed in public health nursing. The Minnesota Practice Enhancement Project describes the development process, instrument, and dissemination of guidelines to practicing nurses.