Has the EBP Culture Transformed Nursing?

Improving Practice,

Improving OutcomesAnnabelle R. Borromeo,

PhD, RN, CNS

WHAT

WHY

HOW

What is

known

What we

know

CHASM NO. 1

CHASM NO. 2

WHAT WE KNOW

WHAT WE DO

KNOWLEDGE TRANSFER

WHAT WE KNOW

What is

known

What we

know

CHASM NO. 1

A QUICK ( 5-SECOND) TOOL TO DETERMINE WHETHER SOMEONE HAS WHAT IT TAKES TO

BECOME A GOOD NURSE

Snap (or click) your fingers

Forefinger

E-Test

1. Close your eyes

2. Snap the fingers of your dominant hand 5 times

3. With your forefinger, quickly draw the letter E on your forehead

The 5-second E-Test (Galinsky & Schweitzer, 2015)

A B E to self

E to others

Patients experiencing hypotension and shock should be placed in Trendelenburg position

to improve blood flow to the heart and brain.

True or False?

REFERENCES

Bridges N, Jarquin-Valdivia AA. Use of the Trendelenburg position as the resuscitation position: to T or not to T. Am J Crit Care. 2005;14(5):364–368. http://ajcc.aacnjournals.org/content/14/5/364.full.

Johnson S, Henderson SO. Myth: the Trendelenburg position improves circulation in cases of shock. Can J Emerg Med. 2004;6(1):48–49.

Makic MB, VonRueden KT, Rauen CA, Chadwick J. Evidence-based practice habits: putting more sacred cows out to pasture. Crit Care Nurse. 2011;31(2):38–62.

INFORMATION OVERLOAD

CHASM NO. 2WHAT WE

KNOWWHAT WE

DO

KNOWLEDGE TRANSFER

innovation is a process, not an event

Rogers, 1962

There is clear evidence that nurses are at risk for making more errors with longer work shifts. They also have more needlestick and musculoskeletal injuries, drowsy driving, sleep deprivation, and fatigue.

The greatest barriers to changing this staffing model are staff nurses and nurse leaders. Staff nurses reportedly like, demand, and have become accustomed to the 12-hour model, currently the norm in many organizations. Staff nurses like the increased income potential and perceive they have more time off. Nurse leaders resist the major organizational culture revolution they perceive would be required for change. In addition, the 7 p.m. to 7 a.m. shift facilitates staffing the 3 p.m. to 11 p.m. shift, a slot reportedly most difficult to staff.

Gieger-Borwn & Trinkof, 2010

1. Organizational culture revolution2. Difficult when things are still

working

When should the concern for nurses' health and well-being be factored into staffing decisions?

70

How often do we do the

right thing?

How often do we do the “right” thing?

• EVIDENCE-INFORMED

Knowledge Transfer:

Have we made a measurable difference?

What is the STATE of EBP implementa-tion?

Despite dramatic advances in nursing and medical research,

many nurses continue to promote outdated nursing

practices that have been proven ineffective, unnecessary, and in

some cases, downright dangerous. Based on tradition

rather than science, these “sacred cows” are often revered by nurses and hard to dislodge

from practice.

Has the EBP Culture Transformed Nursing?

Improving Practice,

Improving Outcomes

FOR THE INDIVIDUAL

Systematic Literature Review

+ Systematic review

Surveillance

For Institutions

Evidence-Informed

Care PlansClinical

Pathways

For Professional Organizations + Schools

Clinical GuidelinesPOEMs

Sogyal Rinpoche, in his book The Tibetan Book of Living and Dying, organizes the experiences of the bardo of dharmata into four phases: 1. luminosity, 2. union, 3. wisdom, and 4. spontaneous presence.

The Four Phases of the Bardo

References

• Galinsky, A. & Schweitzer, M. Friend or Foe. New York: Crown Publishing.

• Henriksen, K., Battles, J.B., Marks, E.S., et al. (2005). Advances in patient safety: From research to implementation, Vol 2: Concepts and methodology. AHRQ. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK20521/figure/A3537/

• Miller, J., & Hayes, D.D., Carey, K.W. (2015). 20 questions: EBP or sacred cow? Nursing 2015, 46(8), 46-55. Retrieved from https://journals.lww.com/nursing/Fulltext/2015/08000/20_questions__Evidence_based_practice_or_sacred.13.aspx

• Rogers, E.M., Diffusion of innovations, 5th ed. New York: The Free Press. In Titler, M.G., & Everett, L.Q. Translating research into practice: considerations for critical care investigators. CritCare Nurs Clin North Am (2001) 13(4): 487-504. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2659/figure/ch7.f2/?report=objectonly

• Titler, M.G. (2008). The evidence for evidence-based practice implementation in Huges, R.G. (ed.) Patient Safety and Quality: An Evidence-Based Handbook for Healthcare Research and Quality. Chapter 7. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK2659/

Geiger-Brown, J., & Trinkoff, A.M. (2010). Is it time to pull the plug on 12-hour shifts. Part 1. The evidence. JONA, 40(3), 100 – 102.