The Growing A Culture of Clinical Inquiry Project: An Innovative Methodology for Asking Questions and Sharing Knowledge Among Nurses in an Acute Care Pediatric Setting

Saturday, 16 November 2013: 3:35 PM

Natasha Laibhen-Parkes, RN, BSN, MSN, CPN
General Pediatric Care Department, Children's Healthcare of Atlanta, Atlanta, GA

Learning Objective 1: Describe a framework for promoting a culture of clinical inquiry within the acute care setting.

Learning Objective 2: List evidence-based strategies that can be used to promote questioning, access, and synthesis of knowledge among pediatric bedside nurses.

The Institute of Medicine has set a goal that by 2020, 90% of all healthcare decisions in the US will be evidenced based (EB), but the majority of nurses are still not consistently implementing evidence-based practice (EBP) in their clinical settings.  This project was a yearlong initiative conducted on two units within a large tertiary care pediatric hospital to create an environment where nurses were empowered to ask questions about their clinical practice and encouraged to search for best evidence supporting their practice. 

A variety of EB strategies were used to attain and maintain a culture of clinical inquiry, which included: PowerPoint presentations, EBP unit champions, clinical question (PICO) boxes, Clinical Inquiry Posters, Summaries of Evidence (SOE), Layman’s SOE, Medical Librarian inservices, and Journal Clubs.   About 75% of 49 nursing staff contributed questions to the PICO box and Clinical Inquiry Posters. 

After a 12 month period, 34 PICO questions and 23 clinical inquiry questions were generated.  In response, 26 SOE and 7 layman’s SOE were disseminated for staff review. 

The nursing units have a growing database of PICO questions, an active Journal Club, and increased staff comfort and competence in formulating PICO questions.  Journal Club members are more proficient in performing literature searches and critical appraisal techniques.  The use of validated EBP strategies can empower nurses to ask questions about their clinical practice and encourage nurses to acquire and critically appraise evidence to support or refute current practices. 

As the climate of EBP evolves within the clinical setting, nurses need to have confidence in asking clinically relevant questions to truly be agents of change and utilize innovative strategies of accessing and sharing EB knowledge to keep up-to-date and informed.  This is particularly important in the pediatric setting where strategies to promote EBP among nurses have lagged behind adult settings.