Sunday, 17 November 2019: 10:45 AM
Improving the care of hospitalized patients has been the focus of nursing since Florence Nightingale. Today, patient care has become more complex lending to the advent of the IOM report and value-based purchasing initiatives through the Centers for Medicare & Medicaid Services (as a result of the Patient Protection and Affordable Care Act). These initiatives provide even more motivation for optimizing nursing practice environments to enhance patient outcomes (IOM, 2011; Kavanagh, Cimiotti, Abusalem, & Coty, 2012). The use of evidence-based practice (EBP) has been accepted as the best way to provide high quality patient care and positively impact patient outcomes. However, barriers exist when facilitating an EBP among hospital nurses especially within small community hospitals. Identified barriers include organizational culture, nurses’ lack of knowledge related to EBP, or desire to incorporate research evidence into practice (Middlebrooks, Carter-Templeton, & Mund, 2016; Schoonover, 2009). In fact, Middlebrooks and colleagues (2016) highlighted several influences that impacted whether or not staff would implemented an EBP project. Successful EBP programs adopted by nursing staff incorporated a mentor (such as nursing research expert) and a facilitator of learning (a medical librarian) along with foundational resources such as computer and library access. Breckenridge-Sproat and colleagues (2015) went one step further and identified that individual nursing commitments to an EBP culture within a health care system may wane but a unit-level EBP mentoring program could be sustainable even when organizational structures change. The purpose of this EBP educational curriculum was to enhance patient outcomes and ensure compliance with the new federal reimbursement regulations in a small rural community healthcare system. The curriculum used several strategies to promote a culture of evidence-based nursing practice. A barrier of leadership buy-in was avoided as top administrators in the rural healthcare system recognized the importance of using current and best research in practice to enhance the care and health of the patients. Top hospital administrators (CNO and CEO) identified that the majority of nurses within their facility were associate degree prepared and did not know what EBP was or how to achieve it. A nursing clinical research specialist was hired to help the nurses understand EBP and translate the evidence into practice. The nursing clinical research specialist’s first steps included putting foundational supports in place such as computer access for staff nurses along with computer software programs to make citation retrieval easier. Partnering with the healthcare system’s medical librarian and a doctoral prepared nursing representative from a university were also included among the first steps to build an EBP curriculum for staff nurses. Additional steps included negotiating with unit managers to permit staff nurses time away from their units to attend the face-to-face didactic modular courses. Unit managers agreed to permit selected staff nurses up to four hours per month of unit counsel (non-productive) time to attend the education sessions. The curriculum RAIN 2 was developed by collaboration between the nursing clinical research specialist and the doctoral prepared nursing representative. RAIN 2 a modification of RAIN program (Breckenridge, 2011) was tailored to RNs who had little or no knowledge of the research process or EBP. The goal of the RAIN 2 curriculum was to help nurses understand, explore, and begin planning EBP projects. RAIN 2 consisted of four modules provided to staff nurses in didactic format during four monthly-shared governance council meetings. Hands-on skill building was also incorporated into the didactic sessions to augment different learning styles of the nurses. After a successful first year, RAIN 2 was delivered to staff nurse throughout the healthcare system (2012-2015). Typical EBP program evaluations include literacy skills assessment, EBP attitudes and perceptions, along with knowledge of EBP upon curriculum completion (Middlebrooks et. al, 2016). Outcomes of the RAIN 2 program demonstrated sustainability and were measured in terms of the number of successfully completed EBP and research projects. From 2012-2015 staff nurses conducted on average between 15 and 20 EBP projects per year and at least one formal research project (institution review board approved) per year for a total of four research projects during the four years of the program. The RAIN 2 program was not limited to nurses. Physicians and medical students were also welcome to participate. The EBP projects ranged in scope from preventing skin breakdown or hospital acquired pressure ulcers as a result of incorrect anti-thrombotic stocking use on a medical/surgical unit, decreasing the prevalence of urine catheter associated UTIs by creating a catheter removal nursing protocol, enhancing the effectiveness of hourly rounding to prevent falls on a medical unit, and adopting the routine practice of skin-to-skin (“baby friendly” initiative) on a mother/baby unit. In addition to the EBP projects there were four research projects. These included the following: changing the time of routine medication administration on a medical unit to improve medication administration errors and patient care, implementing a slow back massage intervention on an inpatient rehabilitation unit to improve patient satisfaction with their nursing care, investigation into patient adherence of prescribed neutropenia diets for lung cancer patients, and activating patient education on a post partum unit to improve patient education viewing and discharge times. Success of the program was also assessed by dissemination of completed projects. Nurses at the rural community hospital presented their 15-20 EBP and research projects annually in poster format at a designated “Research Day” held during nurses’ week within the healthcare system. Several posters were also accepted for presentation at regional conferences. Two of the research projects were accepted for poster presentations at regional and international conferences and one of the research posters was also disseminated as a published journal article (citation removed for double blind peer review). Sustained success of the RAIN 2 curriculum was evident in the above mentioned outcome measures and should be considered by other rural community hospitals seeking to achieve nursing excellence with a goal of improving patient outcomes.