Diffusion of Evidence-Based Practice in Clinical Settings

The single most important product of clinical nursing research and integration of evidence-based practices is the benefit it offers to patients.  Despite the availability of research that supports the use of interventions whose efficacy has been documented, providers do not consistently implement research-based practices. Moreover, results of the research utilization surveys demonstrate that staff nurses need support throughout the process of integrating evidence-based practice into delivery of care and need to be fully informed about the process to follow and resources available to assist them with this work.  To improve safe patient care and quality at the bedside, evidence-based practice behaviors do need to be promoted and fostered in staff nursing practice. 

To demonstrate the integration of the evidence-based practice process into clinical practice an example is shared from a U.S.A. academic Magnet hospital.  Using a Staff Nurse Fellowship program, an evidence-based practice project was conducted to improve postoperative handover from the Operating Room to the Intensive Care Unit.  The purpose of the project was to design an evidence-based guideline and create a standardized handover tool to improve postoperative handover communication, collaboration and decision-making.  Research shows ineffective communication between nurses and physicians is the single factor most significantly associated with increased hospital mortality.  During the transitions of care, inadequate communication is implicated in nearly 70% of all errors and adverse events.  These findings prompted the Joint Commission to require health care organizations to implement standardized handover protocols and facilitate communication between providers. 

Using an evidence-based practice model the levels of evidence ranging from systematic review, observational studies and expert opinion were synthesized to formulate an evidence-based guideline and a handover tool.  All members of the multidisciplinary team who were involved with the care of the patient were asked to be part of the process.  The following interventions were performed for the project: 1. An evidence-based guideline and tool to standardize postoperative handover, 2. Pre-education knowledge assessment of 62 staff, 3. Multi-disciplinary education sessions. 4. Post education knowledge assessment of 52 staff, 5. Coaching and mentoring, 6. Evaluation of adherence to the EBP change.  The outcomes measured including a pre and post knowledge survey, satisfaction and work environment survey, and practice outcomes.  

During the critical period of a patient handover report the standardized tool and process did enhance communication, collaboration and decision-making among health care providers.  Results indicate that the structured handover tool and process improved accuracy (p=0.006) and consistency (p=0.001) of information shared during the handover, thus decreasing omission of any critical information.  This project demonstrates that an evidence-based practice is crucial for nursing practice and in improving the clinical practice environment.    

In conclusion, nursing is an applied science and the practice of nursing should be grounded in science.  The use of evidence-based practice in nursing contributes to patient and family outcomes that improve health and wellness of the community.