Student/Protege Experience in an Evidence-Based Practice Learning Community

Mrs. Krichbaum designed, implemented and evaluated an evidence-based practice project in partial fulfillment of doctorate of nursing practice coursework. Dr. Heyne served as the clinical preceptor and evidence-based practice mentor in the Evidence-based Practice Learning Community. This protégé project provided standard post-operative teaching tools for patient and family education on pain management for patients requiring an inpatient stay 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. Nearly one third of all children in the United States undergo tonsillectomy and adenoidectomy with many children experiencing moderate to severe pain after surgery. Potential exists for under treatment following hospital discharge. The Rosswurm-Larrabee Model (Rosswurm & Larrabee, 1999) for planned change in practice based on evidence guided the project. Assess the need for change. The existing practice for caregiver preparation did not include standard pain management education. Link the problem to practice. The Ear Nose and Throat department identified that the majority of phone calls received from families within one week after discharge relate to pain management. Unlicensed personnel answered the phone calls and triaged them to a nurse practitioner. In addition, the patient and family had a scheduled follow-up clinic visit. Synthesize the best evidence. The PICOT question that guided the review of literature is: In post-operative tonsillectomy and adenoidectomy patients cared for on the Transitional Care Unit (P), how does a standardized post-operative pain management teaching plan (I), compared to current practice (C), affect parent report of satisfaction with pain education (O) during hospital stay and within the first week after discharge (T)? The literature review yielded eight randomized controlled trials, two controlled trials without randomization, five cohort studies, one systematic review of descriptive studies, two descriptive studies, and one consensus guideline from a panel charged by the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) based on a rigorous review of randomized controlled trials and meta-analyses. The literature revealed that pain is the number family concern in the post-operative timeframe. Strategies reported to improve patient pain management and family satisfaction with post-operative pain management included: telephone follow-up, print pain management instructions, pre-admission education, staff training on pain management, nurse coaching of family on pharmacologic and non-pharmacologic pain management strategies, and a patient diary of pain severity score and pain medication. Design the change in practice. Based on appraisal of the evidence, the recommendation was to standardize post-operative family education on tonsillectomy and adenoidectomy pain management on the inpatient care unit. The project proposal was budget neutral for the department. Anticipated resources include time to develop a written patient education tool, time for a follow-up phone call to assess effectiveness of the pain management plan and satisfaction with the pain management education. The proposed change in practice was reviewed by key hospital stakeholders and then the hospital and university institutional review boards. A standardized teaching tool was developed and approved through the existing review process. Implement and evaluate the change in practice. Advanced practice nurses provided patient and family education in post-operative pain management using the standardized teaching tool. The protégé measured three outcomes: 1) family satisfaction with teaching and understanding of pain management by survey via a tablet prior to hospital discharge, 2) family satisfaction with teaching and understanding of pain management via a phone call survey one week after hospital discharge, and 3) number of phone calls related to pain management families made to the Ear Nose and Throat Clinic after hospital discharge via chart audit. Based on six months of process and outcome data, the team determined to adopt use of the pain management education plan. Integrate and maintain the change in practice. The protégé shared findings at the unit and department level with presentation of a plan for reliably maintaining the practice. The nurse practitioner team will continue to collect outcomes data for a year for identification of any needed revisions. Data collection and analysis is in progress with preliminary findings indicating high family retention of knowledge and family satisfaction with the nurse practitioner teaching. An evidence-based approach to pain, a nurse sensitive quality indicator, has implication for nursing practice. This evidence-based practice project implementing a standardized family education plan with teach-back as an intervention for effective home pain management include the potential to prevent further complications related to ineffective pain management (e.g. dehydration, bleeding) and prevention of hospital readmission (Sikich, Carr, & Lerman, 1997).  

"I entered the Doctorate of Nursing Practice (DNP) program confident in my clinical skills with ten years of clinical and leadership experience.  One of my goals included increasing my knowledge of effective leadership to build my nursing career. In conjunction with DNP course work, I was privileged to participate in the EBP Learning Community at Akron Children’s Hospital by recommendation of my clinical preceptor. This mentoring program was a great fit for me as a DNP student. The experience interfaced exactly with my course work requirements and made necessary coursework feel like a natural part of my nursing growth and career instead of a task to complete. Not only has it helped me in the process of completing my academic requirements, it has served a much better purpose by enhancing my outlook and enthusiasm for the nursing profession. Participating in the EBP Learning Community provided a sense of belonging with other nurse leaders. As I struggled with portions of my EBP project, my faculty and the mentors were there to guide me increasing my confidence and competence as I learned the process. Fellow students struggled with their EBP projects without the benefit of clinical site mentors to help guide help them with project design, implementation and evaluation at their clinical sites. As I described my mentored experience, many expressed a desire to have this valued support and resource available. Mentoring provides a sense of security that pursuing an advanced degree and career path is feasible. Because of the experiential learning opportunity and support in the clinical setting, I am confident that I am developing the knowledge and skills required of a nursing leader with an ability to serve as a resource to my peers."