Western Journal of Nursing Research

Nurses in health care today need to practice from an evidence base. There are many models to guide nurses in using the evidence in their practice; however, often nurses rely on their own mental processes to deliver care and do not rely on protocols or guidelines. The challenge often is not to teach the correct evidence-based practice guideline but to support the nurse to incorporate the guidelines into daily practice. Simulation is a method that can be used in an overall strategy to diffuse evidence-based practice guidelines at the point of care delivery.

When creating an evidence-based practice (EBP) nursing environment became an organizational mandate for the authors’ tertiary care pediatric hospital, they assessed the state of EBP at their hospital. Findings revealed inconsistent use of EBP principles by the nursing staff. Nurses routinely cited literature to inform practice guidelines and performance improvement initiatives, but they lacked skills to comprehensively search available literature and critically appraise evidence for its quality. In addition, evaluating practice changes was not universally used. To stimulate the consistent use of the full scope of EBP, we created a call for competitive awards for EBP projects. Three teams (Of eight proposals submitted) each received $5,000 to implement their projects. Teams also received comprehensive education and were assigned EBP experts to help them implement and evaluate their EBP projects. We report the steps taken to implement and evaluate this approach to stimulating nurses’ interest in and use of EBP.

To maximize patient outcomes, the latest research and practice updates must be disseminated across the patient care continuum to include all members of the nursing team. The Clinical Research Council (CRC) recognized the need to bridge the gap between nursing research and practice, using evidence to decrease variation in practice. To meet this challenge, a Magnet-designated, rural community hospital developed an innovative educational program. This article describes Evidence-Based Practice (EBP) day, an interactive learning environment that engages nursing staff and strengthens their understanding of the science that guides practice. Topics for inclusion were selected based on staff requests, current research, quality improvement data, and institutional priorities. Evidence was provided in a format that supported rapid implementation into practice. Key components of the program included a clinical scenario, internal and external data, nursing interventions, patient outcomes (nursing-sensitive and organizational), and regulatory requirement updates.

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.

The overall purpose of improving work environments in health care is to enhance patient care delivery and improve the retention of nurses by engaging nurses in a model of cultural change that enhances communication and collaboration and actively involves nurses in organizational and clinical decision making. This article reports the findings from a 5-year study that describes an educational intervention for nurse leaders and a unit-based educational intervention for nursing staff, based on the application of Positive Organizational Scholarship (POS) and its impact on nursing work environments.

The purpose of this article was to describe nursing practices (e.g., assessment, interventions) around fall prevention, as perceived by nurse managers in adult, medical-surgical nursing units. One hundred forty nurse managers from 51 hospitals from across the United States participated. Descriptive frequencies are used to describe nurse manager responses. The most commonly used fall risk assessment tool was the Morse Fall Risk Assessment Tool (40%). The most common fall prevention interventions included bed alarms (90%), rounds (70%), sitters (68%), and relocating the patient closer to the nurses’ station (56%). Twenty-nine percent of nurse managers identified physical restraints as an intervention to prevent falls whereas only 10% mentioned ambulation. No nurse manager identified that RN hours per patient-day were adjusted to prevent falls or fall-related injuries. More work is needed to build systems that ensure evidence-based nursing interventions are consistently applied in acute care.

In a pay-for-performance environment, implementing and sustaining evidence-based practice (EBP) is no longer a luxury but a necessity. A critical driving force for EBP is that our communities—the people we serve—expect to receive care based on the best available evidence. Transformational nursing leadership is required to create an infrastructure that influences organizational factors, processes and expectations, thus enabling the sustainability of EBP. The American Nurses Credentialing Center and the American Organization of Nurse Executives provide a framework for nursing leaders to consider when designing EBP implementation structures. This exemplar illustrates nursing leadership competencies with regard to implementation and sustainability of EBP within a multihospital system.

Pressure ulcers (PUs) are among the most common harms experienced by patients in health care facilities. Despite the existence of evidence-based guidelines and protocols for PU prevention and treatment, the sustained success in reducing the development of PUs is elusive. The purpose of this article is to describe how the Translating Research Into Practice (TRIP) model was used to support implementation of a care management solution (i.e., the Daily Project) aimed at preventing PUs. Using a case study approach, the development and implementation of the Daily Project is described in relation to the TRIP model. Initial success was evidenced by a 34% reduction in PU rates and an 86% reduction in missed patient turns 3 months postimplementation of the Daily intervention. Based on our experiences, the TRIP model successfully can assist with the implementation and diffusion of a tool that addresses a complex clinical issue such as PU prevention and treatment.

Rapid response teams (RRTs) improve outcomes for patients through early escalation of care. However, subtle signs of clinical deterioration in children may not be consistently recognized by the bedside acute care nurse and therefore the RRT may not be activated. The Pediatric Early Warning Score (PEWS), an evidence-based tool, provides nurses with a mechanism for early detection using quantitative data. We describe our process and outcomes of implementing and sustaining the use of PEWS at the unit and organizational level using the Plan—Do—Check—Act methodology for performance improvement. Our outcome data indicate that cardiopulmonary arrests were reduced by 31% at the pilot unit level and subsequently 23.4% at the organizational level. Data also suggest that bedside nurses effectively escalated patient care needs without activating RRTs (19.4% reduction in RRT activations after PEWS implementation). Strategies to sustain the positive outcomes of PEWS at the unit and organizational levels are also described.

Patients on a telemetry unit experienced an increase in thrombophlebitis in 2004. The purpose of this research was to determine if peripheral IV amiodarone and vancomycin influenced the incidence of thrombophlebitis in an adult cardiothoracic population. Amiodarone phlebitis rates range up to 27%. In December 2004, Pharmacy diluted the amiodarone concentration to 600 mg/500 ml. By 2005, data demonstrated a consistent decrease in the incidence of thrombophlebitis. However, related to institutional policies and patient safety concerns, the amiodarone infusion concentration was reversed back to 900 mg/500 ml in October 2005. Thrombophlebitis increased after the return to a more concentrated amiodarone IV solution. Vancomycin infusion administration did not change during this time period. A retrospective chart review and observational, before and after study, demonstrated a correlation between amiodarone concentration and the incidence of thrombophlebitis. Vancomycin infusions appeared to prevent peripheral thrombophlebitis in the study population. Data was compelling and resulted in the institution standardizing the more dilute amiodarone IV concentration.