Building an Evidence-Based Practice Learning Community

Christ-Libertin, Cheryl

Leaders have unique roles and responsibilities in implementing and sustaining evidence-based practice across complex clinical healthcare organization for quality patient outcomes. This presenter will share the process and outcomes of application of knowledge and action plan for implementing and sustaining evidence-based practice change following participation in and mentoring at an international workshop that provides a “deep-dive” immersion into evidence-based practice, as well as effective strategies for transforming organizational culture by integrating and sustaining evidence-based practice in clinical organizations. The EBP coordinator completed doctorate of nursing practice clinical practicum hours and now returns as a mentor for the Center for Transdisciplinary Evidence-based Practice (CTEP) interprofessional EBP Immersion offered by The Ohio State University College of Nursing.

The Division of Nursing uses the Advancing Research and Clinical Practice through Close Collaboration Model and the Magnet Model framework to enhance the infrastructure for support of nursing evidence-based practice (Melnyk, Fineout-Overholt, Gallagher-Ford, & Stillwell, 2011; American Nurses Credentialing Center, 2013). The nursing shared governance councils adopted the Rosswurm-Larrabee Model for planned change in practice based on evidence as the Division of Nursing process model. Using this model, evidence-based practice involves the following six interlocking steps:

Assess the need for change: Formulate the PICOT question based on the inadequacies of current practice.
Locate the best evidence: Obtain sources and assess their credibility and relevancy to the research question.
Synthesize evidence: Critically appraise the available research evidence to find similarities and differences in the various approaches.
Design the change: Apply the synthesized evidence to design a change in practice that reflects the new understanding.
Implement and evaluate the change in practice: Implement the change and evaluate the outcomes of interest to determine feasibility and effectiveness in the clinical setting.
Integrate and maintain changes: Reassess the reliability of integration of the change in practice through continuous improvement.

Following organizational assessment of readiness, the next implemented step was development of evidence-based practice mentors to build the mentor skills in evidence-based practice and mentoring and nursing staff skills in evidence-based practice. The American Nurses Credentialing Center (2013) reports clinical practice, leadership, and professional development 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). Four mentors completed the training program at The Ohio State University, with each mentor now supported with organizational resources and supported from The Ohio State University College of Nursing faculty with access to bi-monthly webinars presented by clinicians implementing nursing evidence-based practices across the country, an evidence-based practice ListServ membership, and access to resources including critical appraisal tools. Following successful completion of an evidence-based practice project, an advanced practice nurse is eligible to mentor staff registered nurse employees as well as nursing students requesting the hospital as a clinical site for a capstone or scholarly project. The clinical nursing staff is eligible to apply for mentoring as part of the Evidence-based Practice Learning Community program. The program coordinator, department director, and chief nursing officer select from proposed project topics that align with the nursing and organizational strategic plan and mission. By assuring allocation of resources to projects reflects the triad mentoring relationship. The Evidence-based Practice Learning Community pairs an advanced practice nurse who serves as an evidence-based practice mentor with an eligible registered nurse to work on selected evidence-based practice initiatives. Using the Rosswurm-Larrabee Model as the evidence-based practice process model, the registered nurse 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 evidence-based practice 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 evidence-based practice on patient outcomes. Using an all teach and all learn approach, the learning community approach enhances mentor and protégé learning through experiential learning activities (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 evidence-based practice 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 evidence-based practice 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 evidence-based practice mentors further develop their mentoring skills as they contribute to 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 evidence-based practice initiatives across the care continuum of care through a structured program comprised of education, mentoring, and support for completion of projects.

The learning community has a vision and strategic plan for program expansion. Evidence-based practice 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 evidence-based practice mentors will collaborate with affiliated nursing programs to provide undergraduate and graduate nursing students and interprofessional students with mentored evidence-based practice opportunities. Nurses can complete the first four steps of the evidence-based practice model in an academic classroom setting however, steps five and six require the application in a healthcare environment. The mentors will share their expertise with the learning community participants to proactively match requests for grant proposals to evidence-based practice projects; disseminate outcomes and clinical experience related to a planned change in practice based on research evidence, and partner with researchers when critical appraisal of the research literature identifies gaps in research knowledge. 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 coordinator, mentor, and protégé will share the process and experience of building an infrastructure to support evidence-based practice 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 evidence-based practice, 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.