Evidence-Based Practice Learning Community

Nurse leaders have an essential role in promoting evidence-based practice (EBP) for quality patient outcomes. The Evidence-Based Practice Learning Community (EBP Learning Community) uses the Advancing Research and Clinical Practice through Close Collaboration Model (ARCC) and the Magnet Model framework to enhance the infrastructure for support of nursing evidence-based practice (EBP) (Melnyk, Fineout-Overholt, Gallagher-Ford, & Stillwell, 2011; American Nurses Credentialing Center, 2013).

One aspect of developing an infrastructure to support EBP is use of EBP Mentors (Melnyk, Fineout-Overholt, Gallagher-Ford, & Stillwell, 2011). Mentoring has been proposed as an important method to promote knowledge and skill development (Allen, 2002; Chen & Lou, 2013; Chenoweth, Merlyn, Jeon, Tait, & Duffield, 2013; Fawcett, 2002; Greene & Puetzer, 2002; Hom, 2003; Latham, Ringl, & Hogan, 2011; Oermann & Garvin, 2002; Pinkerton, 2003). The literature supports mentoring in clinical practice, leadership, and professional development, such as evidence-based practice mentors (Kelly, Turner, Speroni, McLaughlin, & Guzzetta, 2013; Krause-Parello, Sarcone, Samms, & Boyd, 2012; Latham, Ringl, & Hogan, 2011; Leung,Widger, Howell, Nelson, & Molassiotis, 2012; Long, McGee, Kinstler, & Huth, 2011; Wilson, Kelly, Reifsnider, Pipe, & Brumfield, 2013). The American Nurses Credentialing Center (2013) reports mentoring as an essential element of nursing satisfaction, workforce recruitment and retention efforts, and identified as a key element of the work environment in Magnet® recognized organizations with value to individuals and organizations (Jakubik, 2008; Jakubik, Eliades, Gavriloff & Weese, 2011). A mentor shares professional knowledge, skills, and experience through a long-term relationship to promote the protégé's professional development (Jakubik, 2008). Mentoring beyond orientation was a key recommendation suggested by novice nurses to enhance quality of work life (Maddalena, Kearney, & Adams, 2012). The argument is emerging in the literature for a mentoring paradigm shift in nursing from dyad to triad perspective. A triad mentoring relationship between protégé, mentor, and the organization in which they work has potential to contribute to nursing staff retention, higher job satisfaction, lower turnover rate, exemplary patient quality outcomes, succession planning, and promotion in addition to the protégé outcomes of learning and feeling supported by the mentor (Melnyk, Fineout-Overholt, Gallagher-Ford, & Stillwell, 2011; Weese, Jakubik, Eliades, & Huth, 2014; Zey, 1991).  

Registered nurse employees and undergraduate and graduate nursing students requesting the hospital as a clinical site for a capstone or scholarly project are eligible to apply for mentoring as part of the EBP Learning Community. The program coordinator, department director, and chief nursing officer select from proposed projects. By assuring allocation of resources to projects that align with organizational goals; this process reflects the triad mentoring relationship. The EBP Learning Community pairs an advanced practice nurse who serves as an EBP mentor with an eligible registered nurse (RN) to work on selected EBP initiatives. Using the Rosswurm-Larrabee Model as the EBP process model, the RN receives education, mentoring, and support for project design, implementation, and evaluation (Rosswurm & Larrabee, 1999). All mentor/protégé dyads meet for group learning, sharing, and work sessions and meet separately for focused learning sessions. The EBP coordinator serves as a resource and additional layer of support to assist the mentor/protégé dyad with project planning for sustained results and dissemination of the impact of EBP on patient outcomes. The learning community approach using experiential learning activities enhances mentor and protégé learning (Kolb, 1984). The mentors implement the six mentoring practices of welcoming, mapping the future, teaching the job, supporting the transition, providing protection, and equipping for leadership (Jakubik, 2008; Jakubik, 2012). During mentor-protégé dyad meetings and group meetings, mentors establish a welcoming atmosphere that encourages team members to feel valued and included as part of a learning community. Use of a process model helps to map a future that is both challenging and feasible with support from the mentoring team creating optimism and encouraging team engagement. The mentors, all advanced practice nurses, mentor protégés in rapid critical appraisal and synthesis of the research evidence as well as share their clinical expertise and leadership skills for planning change within a complex healthcare system. All mentors can be a resource to dyad members in the scheduled group sessions or between scheduled sessions. Designing the planned change in practice as a team supports the protégé in problem solving to identify implementation facilitators and barriers. The mentor knowledge of formal and informal organizational decision-making groups helps assure a safe and protected environment for the protégé. The learning community process models leadership skills and provides protégés the opportunity to develop into EBP champions. At the end of the day, the protégés enhance their novice to expert skills in critical appraisal of the research for development, implementation and evaluation care and patient/family experience. The EBP mentors further develop their mentoring skills as they contribute to the learning community activities. Experienced practitioners benefit from mentoring to improve leadership skills and facilitate career progression (Harriss & Harriss, 2012; Lartey, Cummings, & Profetto-McGrath, 2013; Latham, Ringl, & Hogan, 2011; Owens & Patton, 2003). Of benefit to the organization is the advancement of EBP initiatives across the care continuum through a structured program comprised of education, mentoring, and support for completion of EBP projects.

The program has fourteen mentor/protégé projects in progress. We will highlight a mentor project and a mentor/protégé project to share the process for assessing need for change in practice, linking the problem interventions and outcomes, synthesizing the research evidence, designing the practice change as supported by the evidence, and implementing and evaluating the change in practice. The mentor project focused on best practices for preventing pediatric venous thromboembolism (VTE) after patient screening for VTE risk. The mentor’s team developed a Pediatric VTE Prophylaxis Algorithm and reports on outcomes internally and through the Ohio and National Children’s Hospitals Solutions for Patient Safety (2014). The protégé project provided standard post-operative teaching tools for patient and family education on pain management after tonsillectomy and adenoidectomy and the effect on the outcome metrics of interest; patient satisfaction with the pain management education, pain management during the hospital stay, and pain management within one week of discharge. The protégé project was part of coursework in partial fulfillment of a doctorate of nursing practice. The coordinator, mentor, and protégé will share the process and experience of building an infrastructure to support EBP and implementing planned change in practice based on evidence in a children’s hospital. The teams experience enhanced beliefs about the value of EBP and their ability to implement a planned change in practice based on research evidence. Mentors enhance their knowledge and skills in EBP, individual behavior change, and organizational culture change. The coordinator completes process evaluation using appreciative inquiry and evaluation and formative and summative evaluations with qualitative and quantitative components.   

The learning community has a vision and strategic plan for program expansion. EBP mentors will help imbed research evidence to support clinical practice in partnership with shared governance councils (interprofessional and nursing policy) and provider developed order sets in the electronic health record. Newly hired nurses will build upon their undergraduate coursework through participation in experiential learning related to evidence-based practice as part of a nurse residency program. Expert EBP Mentors will collaborate with affiliated nursing programs to provide undergraduate and graduate nursing students and interprofessional students with mentored EBP opportunities. The mentors will share their expertise with the learning community participants to 1) proactively match requests for grant proposals to evidence-based practice projects; 2) disseminate outcomes and clinical experience related to planned changes in practice based on research evidence, and partner with researchers when critical appraisal of the research literature identifies gaps in research knowledge.