Integrating Evidence into Practice for Impact
Preface Empowering Nurses to Utilize E v i d e n c e f o r Be t t e r P a t i e n t C a r e In pockets across the United States, nurse leaders test innovations to improve care in hospitals, community settings, and the home. Nurses, for example, may develop a detailed care plan with hospitalized patients and their families to help them transition to their home or community-based care. A clinical nurse leader may be tasked with care coordination and chronic care management on a hospital floor. In other hospitals throughout the country, staff nurses who participated in the Robert Wood Johnson Foundation–funded Transforming Care at the Bedside program continue to suggest changes that they think will improve patient care. The changes are tested over a short period and are adopted if they are proven beneficial. This program has improved patient outcomes and given participating nurses leadership skills. Nurses, who make up the largest segment of the health care workforce and spend the most time with patients and their families, are crucial to addressing the many challenges facing our health and health care system: an aging and sicker population, millions more insured, a primary care provider shortage, lack of preventive care, and skyrocketing costs. The Institute of Medicine (IOM) recognized the potential for the nursing field to transform health and health care in The Future of Nursing: Leading Change, Advancing Health, a report that called on the nursing field to be prepared for health system transformation—and stated that nurses must help to lead and shape this change (IOM. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011). The Robert Wood Johnson Foundation and the AARP believed that these recommendations in this report could drastically improve health and health care, so we launched the Future of Nursing: Campaign for Action, a 50-state initiative to implement the recommendations. Nurse leaders and their business, philanthropic, consumer, health professional, insurance, and hospital and health system partners are working to promote nursing leadership, practice, and education. Our health care system needs nurses to actively innovate to improve patient care and it is vital for nurses to employ the best available evidence to ensure that their innovations are, in fact, improving patient care. The landmark IOM report, Crossing the Quality Chasm, definitively stated that health professionals and policymakers must employ evidence-based practice (EBP) to close the quality chasm (IOM, 2001). EBP enables nurses to use scientifically proven evidence for delivering high-quality patient care. One of the challenges, however, is that few nurses are trained in EBP. That is why the Hawaii State Center for Nursing’s innovative statewide EBP program, consisting of an annual workshop followed by an 18-month internship program, offers a promising model of how to successfully use multidisciplinary teams to spread EBP across health care settings. The Hawaii State Center for Nursing program involves 15 health care organizations and 58 evidence-based projects. Projects have ranged from identifying EBPs to minimize fever to prevent secondary brain injury in the neuroscience patient
Nurs Clin N Am 49 (2014) xv–xvi http://dx.doi.org/10.1016/j.cnur.2014.05.014 0029-6465/14/$ – see front matter Ó 2014 Published by Elsevier Inc.
nursing.theclinics.com
xvi
Preface
population to using EBPs to reduce respiratory complications and intensive care unit length of stay in patients with acute cervical spinal cord injuries. In addition to improving care, this program has equipped participating nurses with the requisite leadership skills to advance in their careers. The program is advancing the IOM goals of strengthening nursing education, practice, and leadership to improve patient care. This issue begins with an overview that distinguishes EBP and translation science, followed by a description of Hawaii’s statewide EBP program that uses active and multifaceted translation science strategies to facilitate the rate and extent of adoption of EBP changes. With one exception, the remaining articles describe individual EBP projects from five different health care facilities that used the Iowa Model to guide their work. Each article includes an evidence summary, a description of implementation strategies, an evaluation of the innovation, and lessons learned. These completed projects were initiated between 2009 and 2012, address a variety of topical nursing issues, and, for the most part, focus on preventing complications (ie, blood sugar elevations, increased lengths of stay, extubation failures, noise-related injury, pain, surgical site infections, pneumonia, restraint use, delirium, and fever). An additional article describes the use of evidence to inform simulation-based learning, a possible strategy for ensuring competencies in and compliance with EBP interventions. It is my hope that nursing leaders in other states will read this issue of Nursing Clinics of North America and seriously consider replicating Hawaii’s program to engage nurses in EBP to improve patient care. The Hawaii program demonstrates that health care quality can be realized by employing the best available evidence and empowering the nursing workforce. It also offers a glimpse of the care that the future nursing workforce could provide to create a health system that provides accessible, affordable and quality care to everyone in the United States. Susan B. Hassmiller, PhD, RN, FAAN Robert Wood Johnson Foundation Route 1 and College Road East PO Box 2316 Princeton, NJ 08543-2316, USA E-mail address: [email protected]
Preface Empowering Nurses to Utilize E v i d e n c e f o r Be t t e r P a t i e n t C a r e In pockets across the United States, nurse leaders test innovations to improve care in hospitals, community settings, and the home. Nurses, for example, may develop a detailed care plan with hospitalized patients and their families to help them transition to their home or community-based care. A clinical nurse leader may be tasked with care coordination and chronic care management on a hospital floor. In other hospitals throughout the country, staff nurses who participated in the Robert Wood Johnson Foundation–funded Transforming Care at the Bedside program continue to suggest changes that they think will improve patient care. The changes are tested over a short period and are adopted if they are proven beneficial. This program has improved patient outcomes and given participating nurses leadership skills. Nurses, who make up the largest segment of the health care workforce and spend the most time with patients and their families, are crucial to addressing the many challenges facing our health and health care system: an aging and sicker population, millions more insured, a primary care provider shortage, lack of preventive care, and skyrocketing costs. The Institute of Medicine (IOM) recognized the potential for the nursing field to transform health and health care in The Future of Nursing: Leading Change, Advancing Health, a report that called on the nursing field to be prepared for health system transformation—and stated that nurses must help to lead and shape this change (IOM. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011). The Robert Wood Johnson Foundation and the AARP believed that these recommendations in this report could drastically improve health and health care, so we launched the Future of Nursing: Campaign for Action, a 50-state initiative to implement the recommendations. Nurse leaders and their business, philanthropic, consumer, health professional, insurance, and hospital and health system partners are working to promote nursing leadership, practice, and education. Our health care system needs nurses to actively innovate to improve patient care and it is vital for nurses to employ the best available evidence to ensure that their innovations are, in fact, improving patient care. The landmark IOM report, Crossing the Quality Chasm, definitively stated that health professionals and policymakers must employ evidence-based practice (EBP) to close the quality chasm (IOM, 2001). EBP enables nurses to use scientifically proven evidence for delivering high-quality patient care. One of the challenges, however, is that few nurses are trained in EBP. That is why the Hawaii State Center for Nursing’s innovative statewide EBP program, consisting of an annual workshop followed by an 18-month internship program, offers a promising model of how to successfully use multidisciplinary teams to spread EBP across health care settings. The Hawaii State Center for Nursing program involves 15 health care organizations and 58 evidence-based projects. Projects have ranged from identifying EBPs to minimize fever to prevent secondary brain injury in the neuroscience patient
Nurs Clin N Am 49 (2014) xv–xvi http://dx.doi.org/10.1016/j.cnur.2014.05.014 0029-6465/14/$ – see front matter Ó 2014 Published by Elsevier Inc.
nursing.theclinics.com
xvi
Preface
population to using EBPs to reduce respiratory complications and intensive care unit length of stay in patients with acute cervical spinal cord injuries. In addition to improving care, this program has equipped participating nurses with the requisite leadership skills to advance in their careers. The program is advancing the IOM goals of strengthening nursing education, practice, and leadership to improve patient care. This issue begins with an overview that distinguishes EBP and translation science, followed by a description of Hawaii’s statewide EBP program that uses active and multifaceted translation science strategies to facilitate the rate and extent of adoption of EBP changes. With one exception, the remaining articles describe individual EBP projects from five different health care facilities that used the Iowa Model to guide their work. Each article includes an evidence summary, a description of implementation strategies, an evaluation of the innovation, and lessons learned. These completed projects were initiated between 2009 and 2012, address a variety of topical nursing issues, and, for the most part, focus on preventing complications (ie, blood sugar elevations, increased lengths of stay, extubation failures, noise-related injury, pain, surgical site infections, pneumonia, restraint use, delirium, and fever). An additional article describes the use of evidence to inform simulation-based learning, a possible strategy for ensuring competencies in and compliance with EBP interventions. It is my hope that nursing leaders in other states will read this issue of Nursing Clinics of North America and seriously consider replicating Hawaii’s program to engage nurses in EBP to improve patient care. The Hawaii program demonstrates that health care quality can be realized by employing the best available evidence and empowering the nursing workforce. It also offers a glimpse of the care that the future nursing workforce could provide to create a health system that provides accessible, affordable and quality care to everyone in the United States. Susan B. Hassmiller, PhD, RN, FAAN Robert Wood Johnson Foundation Route 1 and College Road East PO Box 2316 Princeton, NJ 08543-2316, USA E-mail address: [email protected]
