Susan B. Stillwell

Evidence-based practice, step by step: sustaining evidence-based practice through organizational policies and an innovative model.

The team adopts the Advancing Research and Clinical Practice Through Close Collaboration model.This is the 12th and last article in a series from the Arizona State University College of Nursing and Health Innovations Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When its delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved. The complete EBP series is available as a collection on our Web site; go to www.ajnonline.com and click on Collections.

Evidence-based practice, step by step: evaluating and disseminating the impact of an evidence-based intervention: show and tell.

This is the 11th article in a series from the Arizona State University College of Nursing and Health Innovations Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.The purpose of this series has been to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. The final article in the series will be published in the September issue.

Teaching EBP through Problem‐Based Learning

Problem-based learning (PBL) is a teaching method that was developed in the 1980s to enhance education through nontraditional meth ods. Learners’ involvement, usually in small groups, in resolving aspects of an issue or problem is central to PBL. This column cannot provide all there is to understand and know about PBL; however, the parallels between PBL and the evidence-based practice (EBP) process will be discussed along with the effectiveness of the PBL approach in teaching clinicians. Two systematic reviews were conducted that describe what is known about how PBL influences physicians’, nurses’ and other health care professionals’ competencies in clinical settings (Koh et al. 2008; Williams & Beattie 2008). Koh and colleagues found that across 13 studies evaluating the use of PBL in medical school curricula, this teaching method was particularly effective in enhancing learning within the social dimension. PBL promoted competencies in teamwork and social and emotional aspects as well as ethical and legal aspects of health care. In addition, this style of learning promoted competency in self-care, particularly, the attitudes toward one’s own health and well-being. Williams and Beattie focused on the use of PBL in undergraduate health professions’ clinical practicums and found that although PBL could be used effectively in clinical settings to teach students in the health professions, there were barriers that challenged its efficacy (Table 1). Problem-based learning is not a new method of learning/teaching; however, it has only been recently that research has been conducted on it and theoretical underpinnings articulated (Rideout 2001). Apprentices were taught in this way centuries ago (Bennedsen et al. 2008). The Socratic method, guiding learning with probing or leading questions (Rowles & Brigham 2005), is incorporated into PBL. There have been advances in understanding these methods and how they assist learning. Cognitive apprenticeship is a newer term (Bennedsen et al. 2008) that implies learning through collaboration and interaction is the educational goal, not content memorization. Given that the EBP process is focused on learning, critical thinking, and clinical reasoning, using the PBL approach to teaching

National survey shows the majority of nurses use very little research in the first 2 years after their graduation, highlighting a gap between research and clinical practice

Commentary on: ForsmanHRudmanAGustavssonP. Use of research by nurses during their first two years after graduating. J Adv Nurs 2010;66:878–90.

The edematous client: causes, physical assessment and treatment.

Fluid movement between the plasma and interstitial compartments is regulated by a balance of forces at the capillary level. Several factors can alter this balance and lead to edema formation. Since the body has no compensatory mechanism to rid the body of excess fluid once edema appears, it is essential for nurse practitioners to accurately assess clients who may be at risk for fluid retention. This article describes the factors responsible for excess fluid accumulation, client assessment and treatment of generalized edema.