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Learning Objective 1: The learner will be able to name up to five strategies for sustained change in pediatric practice based on multidisciplinary evidence.
Learning Objective 2: The learner will learn of new evidence that was applied to the specific problem of needle stick pain.
Purpose
Despite many strong EBP models for initiating change in pediatric nursing practice, the challenge remains how to sustain new change over time. The purpose of this EBP project was to identify the most effective concepts and strategies to sustain change from a variety of different disciplines, develop them into a framework for changing practice, and test the framework in two pediatric units using the problem of needle stick pain prevention.
Method/Research Question
Iowa model of EBP (Titler, 2001) guided this project in looking for answers to the question: what are the most effective multidisciplinary strategies for sustaining change in nursing practice? Key words included: knowledge transfer, knowledge translation, evidence based practice, evidence based medicine, and change.
Findings
Extensive search of multidisciplinary on-line databases provided summary evidence from: 1) psychology: successful change related to congruent decisions, 2) neuroscience: changes in brain neuroplasticity related to repetition, 3) cognitive behavioral therapy: successful change and axiomatic rules, 4) business: guidelines for making change stick, 5) nursing: change related to cultural assessment. These concepts were incorporated into an implementation framework and strategies for sustaining change in pediatric nursing practice.
Outcomes/Conclusion/Discussion
To pilot and evaluate the change framework, a multidisciplinary group of pediatric nurses and caregivers from the emergency department and post-surgical in-patient units were recruited for an EBP team to improve needle stick pain prevention (NSPP). Baseline data was collected on attitudes, and current pharmacological and non-pharmacological practice, demonstrating that previous strategies to implement EBP for NSPP were inadequate. The framework was used to implement changes in use of NSPP strategies to reduce needle stick pain in children. Two year follow up shows increased use of pharmacological and non-pharmacological practices and increased patient/parent satisfaction with NSPP.