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Evidence-Based Practice Workshops at Saint Agnes Medical Center: Enhancing Skills for the Professional Nurse

by Nancy Crossfield, MALS, AHIP
Library Services Manager, William O. Owen Medical Library
Saint Agnes Medical Center
Fresno, CA

In January 2014, I co-taught workshops on basic research for nurses at Saint Agnes Medical Center (SAMC), Fresno, CA. Tara Reed, Nurse Manager for medical-surgical (med/surg) units, developed the special training to empower nurses to seek and apply evidence-based practice (EBP) as a means of improving departmental quality and patient satisfaction. Many floor nurses did not understand that research was behind changes in patient care and were unable to verbalize or locate research driving current changes. 51% of the med/surg nurses had two-year degrees rather than the BSN, and 64% had been out of school for 10 years or more. Knowledge deficits existed.

The proposed workshops were approved by SAMC’s acting Chief Nursing Officer and CEO, then funded by the Saint Agnes Foundation. RNs were paid for a mandatory 3.5 hour workshop held outside normal schedules. Eighty nurses attended during four identical sessions. The final outline included these topics:

  • Evidence-based practice: drivers, barriers, goals, EBP culture
  • Linking EBP to professional practice, care, core measures, HCAHPS
  • Steps to EBP: formulate question, search sources for best evidence, appraise results, integrate evidence, evaluate effectiveness
  • Applying new knowledge and advancing research skills

Attendees used wireless mini-laptops for my presentation on resources and research. I began by “going local” on our medical library’s intranet pages. We explored links to databases, e-journal link resolver, the Nursing Practice Act, and more. Guidelines were located in DynaMed and from organizations on the library’s EBP page. The Institute for Healthcare Improvement (IHI) site intrigued participants because it included some sister hospitals as research mentors. Boolean operators were introduced (cookies AND ice cream NOT sprinkles), along with PICO, to formulate clinical questions. A brief PubMed tutorial was run and other self-help tools were shown before building simple queries in PubMed and CINAHL. Searching for “rounding” illustrated content differences between the databases. Attendees practiced searching, simple limiting, specifying article types, and saving and e-mailing citations. Then they found articles using our link resolver. One hour and a quarter was not enough time for all of this, but many resources were introduced. The nurse manager gave an inspiring finale emphasizing application of knowledge to nursing practice, discussing Rogers’ Diffusion of Innovations theory, and challenging nurses to become early adopters of change.

What did I learn during the process? First, I was appalled at how complacent I’d become about library users! 80-90% of workshop attendees had neither been in the medical library nor seen the library intranet pages. The library does market services and acquisitions in the staff newsletter, works with committees, and sends marketing letters to new employees, but more is needed. The second big lesson was that nurses who have been out of school for many years or who have two-year degrees may never have had ANY exposure to the most basic research concepts. I assumed they knew about databases but had no time or inclination to use them. I was stunned when an older nurse marveled, “That Poob-Med? I never knew such a thing existed!” 95% of the group had never heard of PICO, and at least 75% had never run a literature search. Knowledge deficit on both sides of the podium! Thirdly, although session attendance was mandatory, enthusiasm could be developed. Within days, five RNs came into the library for help devising searches and finding articles, and I was asked to give a brief introduction to library resources for a reorganized nursing council.

The workshops highlighted library services and expertise, and they laid groundwork for future sessions on nursing research. Attendees will be surveyed later to see if they retain knowledge of EBP, feel more confident of their research skills, have begun to incorporate research intentionally into their daily practice, and are evaluating subsequent outcomes. Success will mean seeing improvements in both quality care and patient satisfaction scores.

Approval is being sought to extend this workshop to all SAMC nurses. New criteria have been proposed to implement EBP competencies for RNs advancing to Levels III or IV on the hospital’s clinical ladder. Competencies would require nurses to locate articles or guidelines on med/surg topics, share the information, and show how they implemented EBP recommendations. I shall certainly build on these sessions to improve awareness of library resources and expertise, and look forward to participating in the next proposed workshop, “Enhancing the professional nurse’s ability to critique research articles!”

Selected References

Transforming health care from the inside out: advancing evidence-based practice in the 21st century. Fineout-Overholt E, Melnyk BM, Schultz A (2005). Journal of Professional Nursing. 2005; 21(6):335-344. PMID 16311228

The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Melnyk BM, Gallagher-Ford L, Long LE, Fineout-Overholt E. Worldviews on Evidence-Based Nursing. 2014 Jan 21. [epub ahead of print]  PMID 24447399

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