An Organizational Approach to Adoption of Technology to Enhance a Nursing Evidence-Based Practice Culture

Sunday, 8 November 2015: 11:20 AM

Leslie S. Norman, MPH, BSN, RN, NEA-BC, FACHE
Administration, Memorial Hermann Sugar Land, Sugar Land, TX, USA
C. Denise Neill, PhD, RN, CNE
Nursing, Memorial Hermann Sugar Land, Sugar Land, TX, USA

Evidence-based practice (EBP) is a process nurses use to make clinical decisions that are supported by research evidence.  The evidence-based nursing process has four distinct steps:  1) identify the problem, 2) search literature, 3) evaluate the evidence, 4) choose interventions and justify with evidence.  Nurses and other professionals need data to support and sustain EBP decisions.  Technologies are rapidly expanding to enhance the ability to easily include EBP findings in clinical decision support systems.

A review of the literature identified benefits and challenges associated with technology use for promoting EBP.  Results concluded that the adoption of devices is dependent on type used and noted that EBP data was derived more frequently for medications and nursing searches.  Use of hand-held technology improved nurse’s awareness of resources for EBP.  The literature also identified a cycle of learning in which nurses need data to support EBP.  Technology provides a means to support data management and research provides efficacy of intervention.  For example, technology can be incorporated into workflow via tasks and reminders.  Technology can be used for screening and data collection as a way to minimize bias and standardize approaches to treatment.  The consistent use of an intervention provides effectiveness data for determining whether or not to continue implementing EBP findings.  For EBP to be sustainable, the facility must have an IT framework to guide information to the end user.

When selecting technology to support EBP, nurse leaders must consider barriers to adoption of technology and barriers to EBP.  Many nurses express a lack of time to research/read the information and incorporate knowledge shared by others.  Another issue with technology is related to lack of access and skills such as improper training on EMR; lack of computer literacy; not enough equipment; poor locations for access; and lack of research search skills.  These limitations result in nurses relying on manual formats and non-scholarly sources such as Google or Wikipedia for information to guide clinical decisions.  Because of the limited skill set and lack of EBP at point of care, nurses more apt to use sources imbedded within applications (i.e. EBSCO, Mosby). 

One small community facility is combining the successful adoption of technology with two performance improvement (PI) methodologies to promote an EBP culture.  Through adoption of the Banner Health/Cerner Corp- Care Transformation framework and implementation of the Baldrige Approach-Deploy-Learn-Integrate (ADLI) with Process Design Methodology (PDM), the facility is developing a strong culture of EBP. 

The role of the chief nursing officer and other nursing leaders was to take responsibility for assuring a culture that supported EBP.  Support was demonstrated through access to technology, supporting educational advancement, both formally and informally, and ensuring that skills training was ongoing.  Nursing leadership worked with leaders in other health related professions to set the organizational vision and expectations.  The vision and expectations were communicated to nursing staff and direct care nurses were provided release time to participate in the Nursing Practice Council activities.  One focus of the regular meetings was to provide the members with skills and knowledge to influence practice decisions using EBP data. 

There are numerous ethical considerations when adopting technology to implement nursing evidence-based practice.  Nurses must consider patient autonomy.  Patients may not want to comply with EBP recommendations.  When nurses and other health care professionals push technologies on patients, there may be a real or perceived loss of empowerment.  The American Nurses Association Code of Ethics emphasizes the need to maintain privacy and security with all data. 

Technology usage is not the ultimate goal.  Technological and EBP implications for nursing include understanding that technology is a gift.  The successful implementation of technology to support and enhance EBP requires a shared vision with colleagues.  Technology must be intentionally designed to incorporate EBP.  There are two key elements for success.  Technology must be recognized by nursing in daily practice.  Technology choices must support nurses’ decision-making and workflow to improve quality and safety. 

In an effort to increase recruitment and retention of quality nurses, this small facility began by evaluating the nurses understanding of EBP.  The CNO restructured the nursing leadership and practice committees.  The restructuring effort created a Nurse Practice Council where staff nurses actively participate in a grassroots efforts to promote an ever improving culture of safe, quality care based on current evidence.  Nurses identify areas of practice concern.  These nurses utilize technology in consultation with the data analyst, research consultant, and other members of the quality improvement team to evaluate the interventions.  The facility has implemented several evidence-based clinical interventions.  Direct care nurses are taking ownership of the patient outcomes and are involved in making decisions to promote quality care.  The ultimate goal is to improve outcomes for the patients and families and the nurses to fulfill the mission of the institution to be a top community hospital.