Ever have one of those shifts where you don’t get a chance to sit down, you have to document on the run, and you’re forced to juggle a never-ending list of tasks? Your feet ache, your head pounds, your e-mail inbox is overloaded, and your heart gets trampled more than once. Then you sneak off to the bathroom for a long overdue stop, and see a sign on the wall that asks, “Have you checked for new evidence-based practices today?” Something deep inside you wants to scream, “Who has time for research?!”
Research. For many, this word conjures up such thoughts as “boring,” “irrelevant,” and “too much work.” Evidence-based practice may seem like a luxury, a low-level priority, an endeavor for really smart people who like statistics and have plenty of extra time—and that would not be you.
But evidence-based practice, which integrates research findings with nurses’ clinical judgment, is no mere passing fad. It has the potential to improve patient outcomes, reduce errors, and help make healthcare systems more financially stable. No wonder healthcare consumers and administrators continue to call for nurses to make competent decisions based on good science.
So how can a busy nurse find the time to obtain research findings, decide if the findings are ready to use in practice, and plan practice changes accordingly? Read on for tips on grabbing research on the run.
Call in your order
Evidence-based practice is most effective when we plan ahead for the evidence we need. But as an emergency activity, a literature search can be ineffective and cause us to use evidence ineffectively. So follow these steps to have the evidence ready when you need it.
- Identify common questions you and your coworkers have about the types of patients you see most often. For instance, you might jot down, “What’s the best practice for preventing falls in acutely ill geriatric patients?”
- Capture researchable questions using the so-called “STICK” method: Place adhesive-backed note pads near points of care so nurses can scribble questions that arise from their practices. Post the notes on a display board in your work area. Later, the nurse or committee responsible for monitoring the board can collect questions and begin the process of finding answers.
- Do a literature search and critique research studies that address your key questions. Until you become expert at finding and evaluating research, seek help from a medical librarian, a nurse researcher, an academic partner, or an advanced practice nurse (APN).
- Crystallize key conclusions from the literature and let experienced nurses verify what you’ve found. Various levels of evidence exist; some research is more rigorous and more ready to be used in practice than other research. Evidence-based practice is enhanced when colleagues work together and share perspectives on how valid and useful research studies are. (See “I need to know now!” by clicking on the PDF icon above.)
- Share what you find with colleagues. Post a short summary on brightly colored paper in a place where nurses gather. Publish highlights in a unit newsletter. Discuss what you’ve read with colleagues during patient rounds. Create a website where nurses on your unit can archive key evidence reviews and conclusions. Then when you have a question but lack time to seek the evidence yourself, you can log on and find practice guidelines already archived for easy access.
Get it and run
Try the ideas below to make research readily available and relevant for everyday practice.
Evidence-based practice boxes
Select a priority issue for your unit, such as use of leg compression devices to prevent blood clots. In a clear, medium-sized plastic box with a lid, place brightly colored papers with copies of evidence-based guidelines, a small 4″ x 6″ photo album with photos and images related to the topic, a texturized item such as an antiembolic stocking with directions for measurement or correct placement written on it in indelible ink, a case study of evidence at work in the care of a patient on your unit, and a journal article with a quiz. Offer a prize for completing the quiz.
Post journal articles on a bulletin board in an area where nurses commonly spend time. Highlight key conclusions or add a colored insert summarizing practices recommended by the research. Provide extra copies for nurses to grab when they pass by, perhaps to be skimmed later.
Ask an expert
Making experts available in the patient-care setting is one way to engage ambivalent nurses who won’t go to a different part of the building for a planned session. Invite an APN or interdisciplinary colleague to come to your unit for coffee once on all shifts. Nurses can drop in and discuss mutual research interests.
Use traveling posters
Traveling posters can be shared among units to announce new evidence-based practice changes. Make the poster simple and precise so it’s an easy read for nurses on lunch or a quick break. (If you add too much content, this could deter a nurse who doesn’t have time to read a lot of information.) Make a replica of the poster’s content and offer it as a pick-up page for nurses to carry with them for review.
Set up an evidence-based practice cart
Prepare a rolling cart to share among units. Relate all information on the cart to a single systemwide priority, such as preventing pressure ulcers. Nurses can stop by the cart to look over graphs of in-house data, literature review highlights, a new evidence-based assessment tool, or new product samples. Perhaps a portable laptop can be perched on the cart so nurses can do quick literature searches. During high traffic hours, carts can be staffed by unit-based research champions, educators, or APNs. Have forms ready to capture new researchable questions that come up during impromptu discussions.
Other ways to make research more accessible
If you’re a manager, try to budget the money for online access to literature databases from each computer on the unit. Post directions to access databases on the desktop.
Encourage your unit council to order hard copies of journals to keep in a visible location. And when sharing an evidence-based practice blurb at staff meetings, make a copy and tape it to each nurse’s locker or post it on a bulletin board outside an elevator. Postings next to elevators get more attention because of traffic flow and wait times.
Offer special treats now and then
Occasionally offer extraordinary evidence-based practice exposures. Variety can be refreshing, especially when the unit is less hectic. Include individual recognition and group celebrations to motivate nurses to participate.
- Promote a “Research Question of the Week” with an APN’s help. The question might be in a simple multiple-choice format; post the answer each Monday with a reference cited. Or the weekly question might be more in-depth, requiring nurses to skim an article or do a quick literature search. Nurses who answer the question correctly could have their names posted on computer screensavers for the next week.
- Announce an evidence-based practice contest. Have nurses submit stories of how they use evidence in practice. Ask an APN to evaluate and rank submissions. Celebrate the winner in an appropriate way.
- Invite an APN to conduct research rounds on your unit. Encourage staff nurses to co-lead, and provide time away from the bedside to prepare. Select a complex patient who will be on your unit for several days; then analyze issues and collect evidence to address the patient’s care. Gather nurses in a roundtable format for discussion. Present on three consecutive days at times most nurses can attend for 15 to 30 minutes; provide chocolate or fruit. Alternatively, start a unit-based journal club.
- Find a mentor as you develop confidence in your evidence-based practice skills. But know that while nurses can gain competency in research skills through mentored practice and education, becoming an expert in evidence-based practice may require further education and extensive experience.
Changing the culture
Adopting evidence-based practice changes requires a little extra effort at first. Coworkers may resist new ways of doing things. But because you know patient safety and high-quality care depend on evidence-based practice, you’ll persist. You won’t wait until things slow down (they rarely do). As evidence becomes readily accessible and a common topic of professional conversation on your unit, you may begin to notice small but significant changes in the decisions you and your colleagues make. For instance:
- Perhaps Brad gets to work a few moments early and skims a research article on factors that predict medication errors. He watches carefully for these factors during his shift and avoids at least one potential error. He tells you about it as you walk to your car after work.
- Jessica comes in on her day off for a session with her mentor on evaluating the readiness of research for use in patient care. It will take more than one meeting, she tells you at lunch, but she’s beginning to grasp the difference between expert opinion and a true research experiment.
- Pat returns from a nursing conference and shares new information on enteral feedings both formally during a staff meeting and informally with colleagues during handoffs. Cultures of evidence-based practice are built one enthusiastic conversation at a time.
Or imagine this: During a busy shift, you’re tempted to look past the behavioral cues of your patient with dementia and assume he doesn’t need analgesia. But you feel an ethical tug. Although you don’t really have time, you decide to check online clinical guidelines for pain assessment in elderly patients and skim the dementia section. Recognizing your patient’s presentation in the list of cues, you choose an appropriate analgesic. You may not realize it then, but your decision may have prevented him from becoming agitated and falling, thus increasing his pain and prolonging his hospital stay.
When you talk to colleagues about what you learned, your unit culture starts to change and others learn from your choices. You experience more job satisfaction because you know you did the right thing.
In a fast-paced nursing world where time is precious and lives depend on your decisions, boldly choose to integrate research into your practice. Plan for what you need, grab it on the run, slow down for a special occasion now and then, and notice the outcomes that result. You’re likely to become a frequent and satisfied consumer of research.
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Melnyk B, Fineout-Overholt E. Evidence-based Practice in Nursing and Health Care. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.
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Renee Twibell is an associate professor in the School of Nursing at Ball State University in Muncie, Indiana and a researcher at Ball Memorial Hospital in Muncie. Debra Siela is an assistant professor in the School of Nursing at Ball State University and a clinical nurse specialist at Ball Memorial Hospital. Gwendolyn Rook is a staff nurse in the neonatal intensive care unit at Ball Memorial Hospital. Erica Wrightsman is a staff nurse in the cardiac intensive care unit at Ball Memorial Hospital. Doreen Johnson is Vice President and Chief Nursing Officer at Ball Memorial Hospital.