The Evidence-BasedScholars Program:

Results and Future Directions Sheila Cox Sullivan, PhD, RN, VHA-CMAssociate Nurse Executive, Research

Julie A. Brandt, MSN, RN, NE-BCAssociate Director Patient Care Services, Nurse Executive

Central Arkansas Veterans Healthcare SystemLittle Rock AR

This material is the result of work supported with resources and the use of

facilities at Central Arkansas Veterans Healthcare System

Presentation Objectives

• At the end of the presentation, the listener will be able to:– Describe the EBP Scholars Program – Discuss results at CAVHS for the EBP Scholars

Program– Describe future directions for the program

Purpose

• To determine the effect of mentoring and release time on the EBP knowledge, skills, and abilities of staff nurses at CAVHS

• Hidden Agenda: To increase the enculturation of EBP throughout our medical center

Background

• What is Evidence-Based Practice?– Intersection of clinical expertise, best available

evidence, and patient values (Sackett, 1996)– Evidence-based practice is defined as the

conscientious and judicious use of current best evidence to guide health care decisions for improving patient outcomes. Use of evidence for clinical decision-making incorporates patient values and patient preferences. (Titler, 2008)

Transdisciplinary Model of EBPFrom Satterfield, J. M., Spring, B., Brownson, R. C., Mullen, E. J., Newhouse, R. P., Walker B. B. et al. (2009) Towards a transdisciplinary model of evidence-based practice. Milbank Quarterly, 87(2), 368-90.

$138

Best Available Evidence

Personal Clinical

Expertise

Patient Values and

Beliefs

EBP

The Problem

Background

• EBP is an essential component of modern nursing practice

• However, many nurses are not comfortable being involved in the EBP process

• Literature supports three reasons for this discomfort:– Not comfortable with research/research process– Lack of knowledge about process– No one who will mentor staff through the process

The Need for Infrastructure

• A systematic method for facilitation of EBP is necessary for enculturation of EBP to be effective (Newhouse, 2007; Burns, 2009)

• Clear evidence of leadership support is required for success (Melnyk & Fineout-Overholt, 2002; Melnyk et al, 2004; Schultz, 2005)

• Transparency in the process is essential (Newhouse, 2007; Stetler, 2003)

Major Challenge• Evidence-Based Practice is not Research!

– Research is a "systematic investigation … designed to develop or contribute to generalizable knowledge”. [45 CFR 46.102(d)]

– That is, Research generates new knowledge• EBP is implementation of extant knowledge

into daily processes• However… let the IRB make that ruling

– Non-Human, Non-Research– Exempt

Methods - Process• Provide opportunity for nurses to complete a

EBP project• Empower chosen nurses to develop a

scholarly methodology in pursuit of EBP• Develop future mentors for other nurses• Involve our APNs in EBP• Address barriers to implementing EBP ideas• Improve our infrastructure

Methods - Proposal

• Staff would receive one eight hour shift per pay period to work with ANE/R for one year

• Responsible for showing progress in project development each year

• Total of 26 days to focus on project

Methods – Application Process

• Proposal included selecting five staff nurses (one from each clinical service line)

• Required to be a direct care staff RN• Minimum requirement was BSN preparation• Staff competed for the positions via an

application process

Methods - Application Process• Staff completed an Application Form

– Proposal sheet– References from

• Peer• Manager

– Identify an APN willing to provide content expertise and obtain a letter of support

– Concurrence of the ANE• Manager and ANE signed an acknowledgment

of the release time requirement

Persuasion Strategies

• Built the proposal around the Business Case for EBP developed by the VHA CNO EBP Goal Group– Facilitated by Dr. Anna Alt-White– Chaired by Beth Taylor

• Brief advertisement: http://vaww.vanod.med.va.gov/collage/N_EBP/

• EBP and Research are a required part of the Magnet Journey

Prerequisites to Application

• Proposal included selecting five staff nurses (one from each clinical service line)

• Required to be a direct care staff RN• Minimum requirement was BSN preparation• Staff competed for the positions via an

application process

Application Process• Staff completed an Application Form

– Proposal sheet– References from

• Peer• Manager

– Identify an APN willing to provide content expertise and obtain a letter of support

– Concurrence of the ANE• Manager and ANE signed an acknowledgment

of the release time requirement

Selection Process

• The Nursing Research Board conducted a blind review of the submissions

• No demographic information was solicited or available

• ANE/R recused from process due to potential conflict as many applicants sought assistance during the application process

Selection Process

• Information provided to the Reviewers:– A table of ideas from each service line– Associated with the applicant’s idea was:

• the presence or absence of the Master’s prepared nurse affiliation

• Also associated was the mean score of the reference forms

• Presence or absence of approval from the ANE

Selection Process

• Instructions were to choose the idea with the broadest potential impact for our medical center

• If members were aware of the identity of an applicant, they were requested to recuse themselves from the discussion and vote

Measuring KSA of Participants

• Used Upton & Upton’s (2006) Evidence-Based Practice Scale

• Reliable – Cronbach’s α > 0.7• Contains 24 items with 3 subscales• Light participant burden as scale is brief• Permission obtained from authors to use the

tool

Upton, Dominic and Upton, Penney (2006) Development of an Evidence-Based Practice Questionnaire for Nurses. Journal of Advanced Nursing, 53 (4). pp. 454-458.

Measurement of KSA

• The participants completed the information three times– At the beginning of the program– Six months later – One year later (when commitment ends)

Outcomes to Date• All projects underway with variable levels of

success• The first cohort of Scholars presented their

work in various settings:– CAVHS EBP conferences– CAVHS/UAMS Scholarship Day– Arkansas Nurses Association Conferences– 18th Annual National EBP Conference in Iowa

• Total of 7 Podium and 26 Poster Presentations

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3

4

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6

7

Overall Scores on EBPQ

BaselineFormativeSummative

Form

Questi

on

Find Evid

ence

Appraisal

Synth

esis

Evaluati

on

Disseminate

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3

4

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Changes in Scholar Knowledge

BaselineFormativeSummative

Workl

oad vs

. Evid

ence

Open to questi

ons

Importa

nce of E

BP

Willi

ngness

to ch

ange

0

1

2

3

4

5

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Changes in Scholar Attitudes

BaselineFormativeSummative

Research IT

Practice

skills

Form Q

uestion

Info source

s

Gap ID

Evidence Retri

eval

Critique

Validity

Useful

Application

Sharing Id

eas

Changing Practice

Review Own Practi

ce 0

1

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Change in Scholar Knowledge

At CAVHS

• 2nd cohort is underway• At six months in, all projects are underway• Already have abstracts accepted for one

national and two regional conferences• Last year’s projects have influenced other sites

within the VISN• Benefit of infrastructure development greater

than anticipated

VISN-Wide Research Project

• “The Effect of Distance Mentoring on EBP”• Objectives:

– To determine the effect of implementing the EBP Scholars Program using a distance mentoring method

– To determine the effect of the distance mentoring program on participants’ Knowledge, Skills, and Attitudes regarding EBP

• VISN 16 funded

Mentors

• Dr. Sullivan: Little Rock; Fayetteville; Shreveport

• Dr. Mistric and Dr. Richey: Houston; Biloxi• Dr. Parker: Oklahoma City; Muskogee• Dr. Bilbrew: Jackson

Expectations of Scholars

• 8 hours release time per pay period to focus on EBP project

• Complete the Clinical Effectiveness and Evidence-based Practice Questionnaire (EBPQ)– Baseline– 6 months– Completion

• Meet routinely with assigned mentor

Expectations of Scholars

• Journal activities• Participate in virtual educational sessions

focusing on ONS Evidence Based Practice Curriculum

• Develop and implement an EBP guideline• Disseminate work

Expectations of Mentors

• Develop trusting relationship• Ensure understanding of the components of

the EBP process• Guide through the Human Research

Protection Program requirements• Meet routinely with assigned mentee• Provide guidance and constructive feedback to

mentee related to EBP processes

EBP Scholar Selection Process

• Participants in the EBP Scholars program:– Chosen by each Medical Center– Each Medical Center Nurse Executive (or designee)

:• Appointed a committee to review all applicants• After review, the committee chose a Scholar to

participate in the EBP Scholar’s program

Inclusion/Exclusion Criteria• Inclusion Criteria

• Must be a full-time employee of a VISN 16 medical center providing direct care at the staff level

• Must have completed a BSN or have successfully completed the Research course in a BSN program

• Exclusion Criteria• Nurses functioning away from direct care (i.e. quality

management, research compliance officer, or as specialists in wound care, fall prevention, and/or patient safety)

• Nurses in leadership support roles (i.e. Magnet coordinator, nurse managers, etc.)

EBP Scholar Selection Based on:

• Project potential – Project must:– Be consistent with medical center nursing mission,

vision, and values– Be consistent with National Patient Safety Goals– Potentially affect more than one unit or service

area– Be within scope of nursing practice– Be Veteran-centric

Preliminary Information

• We have 9 scholars participating• Diverse range of ideas• Already identifying challenges in requirements

for review

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