Do you ever wonder why nurses engage in practices that aren’t supported by evidence, while not implementing practices substantiated by a lot of evidence? In the past, nurses changed hospitalized patients’ IV dressings daily, even though no solid evidence supported this practice. When clinical trials finally explored how often to change IV dressings, results indicated that daily changes led to higher rates of phlebitis than did less frequent changes.
That’s the beginning of the first article in our first “step by step” series, Evidence-Based Practice, Step by Step, launched in November 2009. It won the Nursing Print Media Award for Nursing Excellence from Sigma Theta Tau International; the 12 articles in the series continue to be among the most highly viewed of any AJN articles online.
Nurses know about EBP, but changing practice is another thing.
The continued popularity of the articles made us wonder if the tenets of EBP were still not adequately known by nurses. So we asked the experts, and the result is our new series, EBP 2.0: Implementing and Sustaining Change.
Sharon Tucker, PhD, RN, FAAN, and Lynn Gallagher-Ford, PhD, RN, NE-BC, DPFNAP, FAAN, both at the Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare at the Ohio State University College of Nursing in Columbus, said they found that while nurses know about EBP, they often get stuck in making the change happen and making it “stick” over the long term. These acknowledged experts will be coauthoring the series. The first article, “EBP 2.0: From Strategy to Implementation,” appears in our April issue.
Focusing on the why/how/what of implementation.
This new series will cover strategies to address such topics as the following:
- organizational culture
- leadership structure and support
- EBP resources
- patient populations and settings
- technical and data needs
- educational needs
- reminders and reinforcement
- mentors and champions
- QI tools
- data trending
Articles will also include exemplars cowritten by nurses who have rolled out practice changes in their institutions. We asked them to describe the ‘why/how/what’ of they did and where the ‘potholes’ were and how they dealt with them.
Free webinar on implementing and sustaining EBP.
To kick off the series, we are hosting a free webinar, April 23, from 2–3pm EDT. The series authors will describe their approach to changing practice and “making change stick” over the long term. They will also answer participant questions.
We hope you find this new series as valuable as its predecessor. Be sure to let us know.
Online research isn’t always superior to just mucking around in the stacks. In yet another example of the serendipity in stack-mucking, as a BSN student in 1970 or so I ran across a slim volume entitled, if I remember correctly, “Ritualistic Practices in Nursing,” doubtless long since out of print. (A cursory Google search comes up with around 20 articles with similar themes going back to the fifties.) There were things like how everybody in the ward had a respiratory rate of 20 (or 16 or 18 in some places) even though it was clear that this was unlikely. Of course, nobody ever really expected the nurse’s aide who took the clipboard out to take vital signs to actually count resps for a full minute– on a 45-patient floor, that would take forever. So that number was the accepted convention for “no SOB (shortness of breath).”
Being of a somewhat oppositional nature, I decided to actually count respirations on my next nurse’s aide shift in the geri women’s ward at the local teaching hospital. Most people resting quietly in bed were breathing at a rate of between 8-12, so that’s what I recorded. There was hell to pay, as the nurses thought that was indicative of something dire, like a mass opioid overdose scheme. When I pointed out that if you looked at your watch and breathed every three seconds for a minute (watches had second hands in those days) you would pass out, this was not convincing. I was instructed in no uncertain terms never to do that again. Twenty it was.
However, the book stayed in my consciousness, and has influenced my practice ever since. The title alone was worth the price of admission, as it sent my mind wandering off to all the variations I’d heard of, “Because that’s the way we do it,” and I’d been in patient care areas for only two years by then. That was the wrong thing to say to me (or, really, anybody) then, and it still is today (although it did make me a better teacher years later when I never, ever said that to anybody). Still and all, it’s interesting to see the theme coming around again. Tell me again what strides we’ve made in (OMG) nearly 70 years?