Creating a culture where high quality, patient-centered, interprofessionally-driven and evidence-based care is valued is essential in fostering innovative, data-driven and exemplary patient outcomes. The Institute of Medicine “recommends that 90% of practice be based on evidence by 2020” (Connor, Dwyer, & Oliveira, 2016, p. E1). Black and colleagues (2015) noted that clinical facilities “can no longer afford for EBP to remain an abstract concept or an idealized competency” (p. 19). Addressing clinical inquiry questions is dependent upon an appreciation of evidence-based practice (EBP) and nurse-led research (Wilson, Kelly, Reifsnider, Pipe, & Brumfield, 2013). There are citations denoting how the provision of dedicated, protected time to initiate and participate in EBP is essential for successful outcomes (Wilson, Banner, Austria, & Wilson, 2017). However, this can be challenging (particularly for clinical nurses) because direct patient care often receives higher priority than participation in nurse-led scholarship. Promoting EBP and overcoming the obstacles must be an ongoing process (Gallagher-Ford, 2014). Melnyk and colleagues (2016) cited how the influence and support of chief nurse executives is essential in ensuring that both nurse leaders and nurses working at the point-of-care succeed with scholarly pursuits.
Being cognizant of the importance of strengthening the professional well-being of registered nurses, promoting interprofessional collaboration, and ensuring that nurses have the knowledge and skills to participate in nurse-led scholarship has driven our goal of optimizing patient outcomes. A comprehensive strategic vision was created to align nurse-led scholarly projects with our system-wide Nursing Strategic Plan. Seven priority themes, including foundation, education, acquisition, creation, innovation, translation and dissemination, were identified. The seven themes provide direction for the appraisal of existing evidence, creation of new knowledge, and translation of relevant findings that have a positive impact on patients and staff. “Creation” is defined as nurse-led or nurse-participative scholarly projects in order to add to the body of scientific nursing knowledge or to validate existing knowledge through replication. A Delphi study was initiated in order to determine nursing staff perceptions of future research and EBP priorities.
Methodology
Delphi technique can involve multiple rounds of data collection to reach consensus, and mixed methods (both quantitative and qualitative techniques) may be incorporated (Parlour & Slater, 2014; Wilkes, 2015). Three rounds of data collection and analyses were required to reach consensus. During Round 1, registered nurses who voluntarily consented to participate were asked traditional socio-demographic questions (i.e., age, gender, educational preparation, ethnicity, & years of experience) and one study question, “What do you perceive as research and evidence-based practice priorities?”
For Round 2, all members of the study team conducted line-by-line analyses of the responses, individually categorized them into the seven themes originally identified for the Strategic Vision and met in person to discuss individual categorizations and reach group consensus.
During Round 3, a Likert scale that delineated the major themes and descriptors was distributed to volunteer members of the INSPIRE Teams (comprised of both clinical nurses and nurse leaders) at each pavilion. They were asked to prioritize the descriptors associated with each of the seven themes. Twenty-four members of the INSPIRE Teams agreed to participate in Round 3.
Results
Round 1
Of the 212 participants, 186 (87.7%) were female, 78 (36.8%) identified as Asian, followed in descending rank order by African-American (n=70, 33.0%), Hispanic (n=30, 14.2%), White non-Hispanic (n=27, 12.7%) or other (n=7, 3.3%). The majority of participants (97.2%) were employed full-time and worked at the three inpatient facilities. Participants provided socio-demographic data and 442 narrative statements to answer the main study question about research priorities (qualitative).
Round 2
The research team used the processes previously described in the methodology section to analyze the responses. The 442 narrative statements were subsequently categorized into 28 sub-headers which were aligned with the seven major themes. Each theme had 3-5 descriptors.
Round 3
As previously ascribed, INSPIRE team members (n=24) completed Round 3. Using a Likert scale, participants were asked to rank-order preferences for the top two sub-headers in each theme category (quantitative). For example, the first choice was ranked “1” and the second choice was ranked “2.” Although there were as many as five sub-headers under some themes, only the top two descriptor preferences were ranked.
As examples, the first and second choices for each theme are reported. Top rankings for “Foundation” included: 1) build strong partnerships (interprofessional/multi-institutional); and 2) dedicated, protected time for nurses to participate in scholarship. For “Education,” preferences included: 1) nurse education (leadership, evidence-based practice, research, dissemination); and 2) health promotion. The top choices for “Acquisition” were: 1) best practices and 2) nursing clinical skills. The “Creation” responses were related to: 1) nurse retention; and 2) bullying/incivility and patient satisfaction (tied for second place). The fifth theme, “Innovation,” included: 1) innovative work practices and patient-centered care (tied for first place); and 2) patient experience. Sub-category selections for “Translation” included: 1) nurses’ voice in decision-making; and 2) patient safety. And finally, the priority theme of “Dissemination” focused on: 1) poster presentations; and 2) abstract development.
Implications for Practice
This research study provided a roadmap to further guide the integration of clinical inquiry and nurse-led scholarship. Our nurses are cognizant of creating opportunities and serving as the nexus for collegial engagement (with interprofessional and multi-institutional partners) that fosters scientific discovery and evidence utilization that provides a framework for quality healthcare delivery across the region and globe.