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The Doctor of Nursing Practice (DNP) degree prepares the advanced practice nurse with foundational EBP expertise. The Essential III: Clinical Scholarship and Analytical Methods for Evidence-Based Practice (American Association of Colleges of Nursing (AACN), 2006, p12) states that the DNP program prepares the graduate to:
- Use analytic methods to critically appraise existing literature and other evidence to determine and implement the best evidence for practice.
- Design and implement processes to evaluate outcomes of practice, practice patterns, and systems of care within a practice setting, health care organization, or community against national benchmarks to determine variances in practice outcomes and population trends.
- Design, direct, and evaluate quality improvement methodologies to promote safe, timely, effective, efficient, equitable, and patient-centered care.
- Apply relevant findings to develop practice guidelines and improve practice and the practice environment.
- Use information technology and research methods appropriately to: collect appropriate and accurate data to generate evidence for nursing practice, inform and guide the design of databases that generate meaningful evidence for nursing practice, analyze data from practice, design evidence-based interventions, predict and analyze outcomes, examine patterns of behavior and outcomes, identify gaps in evidence for practice.
- Function as a practice specialist/consultant in collaborative knowledge-generating research.
- Disseminate findings from evidence-based practice and research to improve healthcare outcomes.
Completing a DNP program provided the opportunity to learn the principles of EBP and apply those principles using an EBP process model to complete an EBP project. During the EBP project development, implementation and evaluation the PhD prepared nursing faculty members and a PhD prepared clinical advisor at the implementation site provided mentoring. The focus of the project was use and validation of the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) (Agency for Healthcare Research and Quality, 2006) employed on a pediatric acute care unit when applied in simulation scenarios. This evidence-based set of tools aims to optimize patient outcomes by improving communication and teamwork skills among health care professionals. The most critical skill in learning the EBP process is rigorous critical appraisal of the research evidence; an essential step to empowering others to differentiate between study limitations and fatal flaws that would jeopardize the reported findings. In their role as mentor for the DNP student, faculty facilitates development of this skill and builds the foundation for life-long learning and application of the skill in all settings and roles. A critical appraisal of the literature may also identify gaps in the research evidence that can generate new topics for nursing research. Researchers contribute to EBP involves selecting the best available evidence so in the absence of rigorously designed randomized controlled trials.
A second method for developing EBP expertise is to complete an EBP project through a clinical organization’s Learning Community. The Learning Community involved a DNP prepared mentor and utilization of the Rosswurm-Larrabee Model for planned change in practice based on evidence (Rosswurm & Larrabee, 1999). This project focused on best practices for preventing the pediatric venous thromboembolism (VTE) after patient screening as a high risk for VTE. The mentor’s team developed a Pediatric VTE Prophylaxis Algorithm and reports on outcomes through the Ohio and National Children’s Hospitals Solutions for Patient Safety (2014). The experience was vital for growth as a mentor because it provided an opportunity to learn the organization’s structure and processes for conduct of evidence-based practice projects. Understanding organizational structures and processes enhanced the ability to identify key shareholders, receive feedback, and obtain buy-in and support for the project. Completing a project in the clinical setting with a system approach refined the skills needed for mentoring a protégé in the clinical setting.
A final method utilized for developing EBP expertise involved participation in the interprofessional Center for Transdisciplinary Evidence-based Practice (CTEP) Clinical Immersion offered by The Ohio State University College of Nursing. A half-day clinical leader track provided content related to the unique roles and responsibilities of leaders in implementing and sustaining EBP in their own practice as well as across the organization. In order to be an effective mentor, it is crucial to develop mentoring skills through sharing professional knowledge, skills, and experience in a long-term relationship to promote the protégé's professional development (Jakubik, 2008). Mentoring practices are specific career developmental phenomena facilitated by the individual mentor. Weese, Jakubik, Eliades and Huth (2014) identified and tested six mentoring practices: welcoming, mapping the future, teaching the job, supporting the transition, providing protection, and equipping for leadership. There was a strong positive relationship between the six tested mentoring practices and mentoring benefits (Weese, et al., 2014). As a mentor in a clinical organization hosting the protégé it was crucial for me to be welcoming with the protégé in order for the protégé to become incorporated into the organizational culture for effective learning and application of clinical and EBP project skills. As a nurse practitioner and mentor, I mapped the future of the value of EBP skill development for nurse practitioner practice, as a nurse leader and change agent through discussion of advanced practice nurses impact on patient outcomes through evidence-based interventions. As a mentor and clinical preceptor, teaching the job involved teaching the protégé skills and information regarding use of a process model for effective practice and planning, implementing and evaluating an EBP project. As a clinical site, the organization provided the context for a learning environment supported by the EBP Learning Community (Weese, et al., 2014). The mentor role supports the transition by supporting the protégé in the development of confidence, communication skills, problem-solving skills, decision-making skills and an improved perception of the image of nursing (Weese, et al., 2014). For example, rapid critical appraisal of research evidence for clinical decision-making is a crucial skill for an advanced practice nurse. The EBP Learning Community mentors provide protection for protégé by creating a favorable environment for the protégé's development by working on behalf of the protégé to provide a supportive practice environment and conveying to the protégé that the mentor really cares about the protégé's success (Weese, et al., 2014). For example, mentors facilitate the planned change in a complex healthcare system by identifying stakeholders, decision-making groups, and assistance in navigating the institutional review board process. Within the EBP Learning Community, mentors and protégés share their knowledge and experience with other members. In this way, mentors equip protégés for leadership as they promote opportunities for the protégé to lead others and to develop leadership abilities (Weese, et al., 2014). As nursing leaders must transform care and care delivery, making ‘equipping for leadership’ one of the most relevant mentoring practices that promotes mentoring benefits for protégés and organizations.
See more of: Evidence-Based Practice Sessions: Symposia