How to Bring Evidence-Based Research to Your Nursing Practice
Helpful links to nursing associations, Twitter feeds and news alerts
As you wait for that central line to be inserted, you can’t help but wonder: Is this the best way to do it?
It’s a reasonable question, whether you’re the nurse or the patient. Over the years, we have seen again and again that conventional wisdom and habit (“This is the way we’ve always done it!”) are not necessarily good substitutes for evidence-based care.
Are We Shortchanging Patients?
Unfortunately, a patient’s chances of receiving evidence-based care in the U.S. appear to be about the same as flipping a coin and hoping it comes up “heads.” Back in 2003, a study published in the New England Journal of Medicine found that patients were only getting “about half” of the care recommended in the literature for their conditions.
Even in 2012, a study in the Journal of Nursing Administration noted that only about half of U.S. RNs thought evidence-based care was being consistently practiced in their hospitals. Why? It is not that nurses don’t appreciate the importance of evidence-based care — survey after survey confirms that they do. But there are many obstacles to putting that principle into practice.
The 17-Year Lag
One of the challenges is that it takes a long time for information from clinical trials and studies to be compiled, peer-reviewed, published, read by a wider audience and then applied. According to the Institute of Medicine, it typically takes about 17 years for original research to be put into practice in healthcare. Even then, that research is not applied in the same way across settings.
How can we bridge that research-practice gap? Since healthcare is a complex system involving many professionals from different disciplines, making change happen isn’t always easy. Even if a nurse finds a better way to do something, she or he usually has to get the support of others, jump through the appropriate hoops to get the change approved and then try to convince colleagues to go along with it.
Enemy No. 1: The Status Quo
Sometimes, the most difficult challenge of all can be the very first step: recognizing that there might be a better way to approach a familiar task. For example, you might ask, “Is there recent literature on the best way to insert a central line? If so, how does it compare to my current practice? Are there procedures that would reduce the risk of central line-associated bloodstream infections?”
When we are used to performing a particular procedure a dozen times each shift, we probably don’t stop to analyze technique or think about questions like these — which means we don’t know what we don’t know. What can you do? You don’t necessarily need to start reading scholarly journals at every shift break (although of course that wouldn’t hurt).
However, there are some simple strategies you can adopt to improve your knowledge of evidence-based practice and start bringing those lessons to your workplace.
- Join a professional nursing organization and actively participate.
To stay abreast of the latest nursing research, says Janet Smith, PMHNP-BC, DNP, a psychiatric mental health nurse practitioner in Santa Ana and the president of the Orange County/Long Beach chapter of the Association of California Nurse Leaders, you should “participate in professional nursing organizations … and actively attend scholarship activities of national organizations.”
There are a plethora of professional nursing organizations. Some are specific to a region while others are national organizations for a particular nursing specialty. Professional nursing organizations provide many opportunities to engage, including meetings, speaking events and conferences.
Joining an organization is not only a great way to stay on top of your practice — it is also is an opportunity to network with other healthcare professionals. There may also be benefits, such as access to posted job opportunities, scholarships, webinars and other resources. Your employer might even reimburse you for the annual dues.
Professional nursing organizations use a variety of methods to keep members informed of the latest developments in their practice. Many have regular newsletters and policy briefs. Some organizations even publish their own peer-reviewed journals and standards of practice. You can find a sampling of professional nursing organizations at www.nurse.org/orgs.shtml.
- Attend webinars and conferences and share what you learn.
Smith also recommends attending lectures at local colleges and universities and keeping informed via webinars and conferences. Some organizations offer free or inexpensive webinars on a particular topic, which may also provide continuing education units. In addition to your professional nursing organizations, many nursing schools, healthcare organizations and public health agencies often offer learning opportunities.
Here are some organizations that frequently offer healthcare-related webinars:
◗ UCLA School of Nursing
◗ Children’s Hospital Los Angeles
◗ California Hospital Association
◗ County of Los Angeles Department of Public Health
◗ Institute for Healthcare Improvement (IHI)
◗ U.S. Department of Health & Human Services (HHS)
◗ Agency for Healthcare Research and Quality (AHRQ)
◗ Health Resources & Services Administration (HRSA), through the Office of Regional Operations
◗ Centers for Medicare & Medicaid Services (CMS)
◗ Centers for Disease Control and Prevention (CDC)
◗ National Committee for Quality Assurance (NCQA)
- Sign up for a news alert subscriptions.
There are many healthcare news update services. Most are free subscriptions, typically delivered via email or occasionally text message. They provide relevant updates, alerts or capsule summaries, usually with links to more detailed information. Here is a handful of examples to consider:
Kaiser Family Foundation News
The Henry J. Kaiser Family Foundation (KFF) newsletter offers in-depth coverage of healthcare issues, policy and politics, including both original research and curated stories from publications such as the Wall Street Journal, New York Times and Washington Post. This is a convenient and efficient way to stay up to date on current healthcare news. It is as if you have someone reading all the major news publications, picking out the healthcare-related articles and summarizing them for you, as well as offering KFF’s own research and analysis.
California Health Alert Network (CAHAN)
This is the statewide public health information system, providing announcements and alerts from state health officials. There are also county-specific systems, including:
◗ L.A. County Health Alert Network (LAHAN)
◗ Orange County Health Care Agency Updates
◗ San Bernardino County of Public Health Updates
AHRQ National Guideline Clearinghouse Updates
Signing up for this email newsletter (or other federal email alerts) will also prompt you to sign up for updates from other federal agencies, such as CMS, HHS, CDC and the National Institutes of Health. Occupational Safety and Health Administration (OSHA) Quick Takes Newsletter www.osha.gov This newsletter provides updates on workplace safety and related health concerns.
This is the Robert Wood Johnson Foundation’s newsletter, providing information on their funded healthcare research as well as new grant opportunities.
- Read Twitter feeds.
No, this does not mean you need to tweet a picture of the Nutella-and-strawberry waffle you ate for breakfast. In fact, you don’t need to tweet anything. However, if you have a Twitter account, you can use it to follow reputable news and healthcare organizations and other healthcare professionals. This is another useful way to keep track of breaking health-related news you might not otherwise hear about in a timely manner.
For example, when the American Nurses Association (ANA) updated their Code of Ethics for Nurses, they tweeted about it, giving all their followers an immediate heads-up. Here are a few accounts to consider following. Don’t forget to also find and follow your professional nursing organizations, nursing schools and healthcare organizations.
Health-related news: @USATODAYhealth @USNewsHealth @NYTHealth @CBSHealth @cnnhealth @WSJhealth @KHNews @WorkingNurse
Federal agency news: @EPA @Surgeon_General @WhiteHouse @CDCFlu @CDCGlobal @CDCemergency @CDC_eHealth @CDCgov @AHRQNews @FDArecalls @NIH @HHSGov @CMSGov @NIOSH @NLM_news @theNCI @healthfinder
Healthcare organizations: @CleClinicMD @HarvardHealth @MayoClinic Journals and clinical databases: @medlineplus @JAMA_current @NEJM @CochraneLibrary @PubMedHealth @AmJNurs @PublicHealth @AmerNurse2Day
Nursing and healthcare-related organizations: @RWJF @AACNPolicy @AACNursing @AmericanCancer @WebMD @ahahospitals @STTI @ANANursingWorld @redcross @AAN_Nursing @American_Heart
Some individuals who write on health topics: @PeterPronovost @DavidBlumenthal @GCHalvorson @DrewAltman @Atul_Gawande @DeanOrnishMD @DrFriedenCDC
You can also use hashtags (e.g., #showmeyourstethoscope) to follow specific topics and issues.
- Find practice guidelines
Why reinvent the wheel if the best available evidence has already been reviewed, appraised and developed into practice guidelines? There are many published practice guidelines that may apply to your nursing area. Here are some resources for finding the latest updates:
◗ AHRQ’s National Guideline Clearinghouse
◗ National Information Center Health Services Research Information Central (HSRIC) Comparative Effectiveness Research (CER)
◗ Patient-Centered Outcomes Research Institute (PCORI)
◗ U.S. Preventive Services Task Force – Published Recommendations
◗ ANA Professional Nursing Standards
The list of clinical guidelines is almost endless. For example, searching the nursing category on the National Guideline Clearinghouse website reveals 2016 updates to guidelines on topics such as breast cancer screening, male external catheter management and prevention of retained surgical items, to name just a few.
Also, be sure to periodically check the California Board of Registered Nursing website and any specialty-specific nursing organizations for updated standards of practice that apply to all California nurses or to your particular area.
- Join or start a scholarly journal club.
Journal clubs allow you to share scholarly research with other healthcare professionals in an efficient, interactive way. A club might focus on a particular topic or specialty, and may meet in person or remotely, using video conferencing, group chats or shared online documents to connect. Each member might be assigned to monitor and read certain journals or resources and take notes to share with the other members at the next meeting. Think of it as a less-formal version of the literature review studies that sometimes appear in scholarly journals.
Roque Garvida Jr., RN-BC, MSN, an informatics practice specialist with Kaiser Permanente Panorama City Medical Center, started a virtual journal club at his workplace a few years ago. As a founding member of his facility’s nursing research council, he knew the value a journal club could provide for the council’s research activities. “It keeps nurses up to date about the latest evidence that supports clinical nursing practice,” he explains. Garvida’s role in the group includes leading the topic and journal selection, summarizing findings and disseminating information.
“It clarifies many burning clinical questions, like what is the most effective way of shift-to-shift reporting,” he says. “We found out from the evidence that the best way is incoming and off-going nurses giving report at the bedside using a standardized tool, involving the patient in the conversation and getting their input into the nursing plan.”
- Support methods to improve quality in your workplace.
Another way to embrace research is to engage in quality improvement projects in your workplace and support initiatives that promote use of the latest evidence. For example, the pressure from CMS for “meaningful use” of health information technology has led to the development of clinical decision support systems.
Among other things, these systems prompt the healthcare provider to consider evidence-based interventions that are relevant to the specific patient health information entered in the EHR. By joining in quality improvement initiatives to evaluate or implement tools like this, you can help to bring evidence directly to providers at the point of care.
There are many ways to bridge the practice research gap in healthcare. You should find strategies that make the most sense for you while aiming to avoid information overload. Add one new strategy at a time. Remember, as you find new evidence, you need to critically appraise it, determine how meaningful it is to your practice and explore what steps you need to take to incorporate it in your work. Ultimately, making an effort to stay informed and use the latest evidence will improve care and make patients safer.
The next time you’re waiting for that central line (or other procedure), you can feel more confident that the care you are providing — or receiving — is based on the best available evidence.
Daria Waszak, RN, MSN, CEN, COHN-S, a Long Beach native and an alumna of SDSU and UCLA, is an RN/BSN instructor with over 20 years of clinical and leadership experience. She is currently pursuing her DNP in health systems executive leadership.
This article is from workingnurse.com.