Facilitative Interventions for Nurse Leaders That Enculturate Evidence-Based Practice

Saturday, 28 October 2017

Natalie Kay Lenhart, DNP
Nursing, Education, and Informatics, Self-Employed, Hanover, PA, USA
Barbara L. Buchko, DNP
Department of Nursing, WellSpan Health, York, PA, USA

Many barriers exist to integrating and enculturating evidence-based practice (EBP), the most recent and relevant of which is an organizational barrier that begins at the level of formal nursing leaders. A gap in nurse administrator knowledge correlating safe, quality care with evidence-based practice exists to the extent that necessary resources to overcome known EBP barriers are not allocated (Melnyk & Gallagher-Ford, 2014; Melnyk, et al., 2016; Scala, Price, & Day, 2016). This contributes to poor quality outcomes, fiscal irresponsibility, and staff retention and empowerment issues (Liu, Lai, Ringel, Vaiana, & Wasserman, 2014; Melnyk, 2014; Schifalacqua, Shepard, & Kelley, 2012). Despite nursing administration accountability for EBP integration and an Institute of Medicine (2011) guideline for 90% EBP integration by the year 2020, less than 10-15% of clinicians consistently use EBP to focus decisions and research translation to practice takes 10-20 years or more (Morris, Wooding, & Grant, 2011; Patelarou, et al., 2013). Inconsistent EBP integration results from clinician inability to change organizational cultures and overcome EBP barriers. In order to determine how to enable formal nurse leaders to create a culture of EBP, as well as improve their individual beliefs and use of EBP, the Johns Hopkins Nursing Evidence-Based Practice Model guided the literature review and critical appraisal of the evidence. Ultimately, 38 articles dating from 2008 to present—60% of which was research; half of which was considered high quality—were retrieved from the following databases: Cumulative Index to Nursing and Allied Health Literature, Educational Research Information Center, Joanna Briggs Institute Database, Ovid Nursing Journals, ProQuest, PsycArticles, PubMed, and SAGE Premier. This synthesized evidence—educational interventions, transformational leadership, strategic planning, and a project systems perspective—established the six facilitative interventions used in this quality improvement, pre/post-test, pilot project. The Nursing Process, Lewin’s Change Management Model, and the Five Practices of Exemplary Leadership® Model further enhanced the project design by aligning with recommended best practices from the literature. The pre/post-test reliable and valid scales used to measure outcomes—the Organizational Culture and Readiness for System-Wide Integration of EBP, the EBP Beliefs Scale, and the EBP Implementation Scale—were administered to the nurse leaders prior to, and three months after, the facilitative interventions were implemented. Data from these scales were analyzed using 2-sample t-tests for aggregate scale scores and individual question Likert score movement. Statistically significant improvements for individual questions correlating to the facilitative interventions were noted, but overall aggregate scale scores did not demonstrate statistically significant changes. Further, the swiftness with which the nurse leaders implemented relatively extensive EBP action items from a team-created strategic plan was unexpected, demonstrating buy-in. It is recommended that further research be completed. With modifications, this quality improvement project could be replicated in other facilities, using the key evidentiary factors to adjust the facilitative interventions to the institutional culture and target population. Contributions from this project add to the existing body of knowledge, not to mention the resolution of public health and safety issues and the reversal of fiscal irresponsibility. More importantly, EBP means overcoming resistance to change, which this project demonstrated can be accomplished.