Graduate nursing education programs have incorporated evidence-based practice (EBP) into their curricula. The profession, including clinicians, educators, and now students, have moved toward a “critical mass” of nurses with EBP process competency. Because most EBP models are process-oriented, they can be useful in settings other than the clinical environments for which they were designed; the health policy milieu is one of these (Loversidge, 2016a). European countries and Canada have been credited as early adopters, and have been using evidence to inform policy since the turn of the millenium (Dobrow, Goel & Upshur, 2004; Elliott & Popay, 2000; Niessen, Grijseels, & Rutten, 2000) however the U. S. has lagged behind. The health policy arena presents some substantial differences as compared with the clinical environment, requiring EBP model adaptation. A fundamental difference is intent – in health policy, the term “evidence-informed” has been coined to acknowledge the limits of the uses of evidence, which is indirect, and to inform or mediate dialogue (Campbell et al., 2009; Morgan, 2010). To adapt EBP to the particular needs of health policy, and in particular, to facilitate its use in nursing education as well as nursing regulation, an Evidence-informed Health Policy (EIHP) model (Loversidge, 2016b) based on the Melnyk and Fineout-Overholt EBP model (Melnyk & Fineout-Overholt, 2015), was developed. The EIHP model, and its use in graduate nursing education pedagogy, is described.
Like EBP, the EIHP model combines three essential components; the best available evidence, issue expertise, and stakeholder values and ethics. The steps of EIHP are similar to the steps of EBP, but are modified to account for the differences in stakeholders, political forces, and settings. Other differences between clinical and health policy settings are accounted for in two major ways. First is the intended outcome; whereas EBP establishes an “evidence base” for a practice change, the hoped-for outcome of the EIHP process is to inform and leverage dialogue toward the best possible health policy agenda and outcomes. Second, the primary purpose of the PICOT question in EBP models is to drive the literature search. While it is also used for this purpose in EIHP, The PICOT is additionally used for retrospective deconstruction of pending or existing policy, permitting an in-depth analysis of the policy’s component parts (Loversidge, 2016b).
Strategies for using the EIHP model in graduate nursing education are described. These include guiding students to use the model’s steps to identify, describe, and fully analyze health policy problems, appropriately search for and synthesize the best available evidence for utilization in dialogue toward policy formation, and consider the myriad of issues, stakeholder perspectives, and political forces that affect policy design, implementation, and evaluation. Special attention is given to the use of the PICOT question as a tool for facilitating students’ in-depth analysis of an existing or pending health policy and search for relevant evidence. Consideration is also given to the three EIHP components in students’ analysis of political forces. The model additionally has utility in faculty mentoring of students engaged in health policy clinical settings. Additional implications, including challenges of teaching EIHP in a health policy core course, and positioning the importance of evidence relative to other policy processes, are addressed.
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