By Ayodele Nwosu
Published on May 16th, 2014
Over the past decade, nurses have been part of a movement that reflects perhaps more change than any two decades combined. The recommendation that nurses lead inter-professional teams in improving delivery systems and care brings to the fore the necessity for new competencies, beyond evidence-based practice, that are requisite as nurses transform healthcare.
Directions in nursing education in the 1960s established nursing as an applied science. This was the entry of our profession into the age of knowledge. Only in the mid-1990s did it become clear that producing new knowledge was not enough. To affect better patient outcomes, new knowledge must be transformed into clinically useful forms, effectively implemented across the entire care team within a systems context, and measured in terms of meaningful impact on performance and health outcomes. The recently-articulated vision for the future of nursing in the Future of Nursing focuses on the convergence of knowledge, quality, and new functions in nursing. The recommendation that nurses lead inter-professional teams in improving delivery systems and care brings to the fore the necessity for new competencies, beyond evidence-based practice (EBP), that are requisite as nurses transform healthcare. These competencies focus on utilizing knowledge in clinical decision making and producing research evidence on interventions that promote uptake and use by individual providers and groups of providers.
Following the alarming report that major deficits in healthcare caused significant preventable harm. A key recommendation from the nation’s experts was to employ evidence-based practice. The chasm between what we know to be effective healthcare and what was practiced was to be crossed by using evidence to inform best practices.
In this wide-ranging effort, another significant player was added…the policymaker. For EBP to be successfully adopted and sustained, nurses and other healthcare professionals recognized that it must be adopted by individual care providers, microsystem and system leaders, as well as policy makers. Federal, state, local, and other regulatory and recognition actions are necessary for EBP adoption. For example, through the Magnet Recognition Program® the profession of nursing has been a leader in catalyzing adoption of EBP and using it as a marker of excellence.
Nurses indicated that, while nurses had positive attitudes toward EBP and wished to gain more knowledge and skills, they still faced significant barriers in employing it in practice. In spite of many significant advances, nurses still have more to do to achieve EBP across the board. A recent survey of the state of EBP in nurses indicated that, while nurses had positive attitudes toward EBP and wished to gain more knowledge and skills, they still faced significant barriers in employing it. One example of implementation of EBP points to the challenges of change. The evidence-based program.
Provide patient-centered care – identify, respect, and care about patients’ differences, values, preferences, and expressed needs; relieve pain and suffering; coordinate continuous care; listen to, clearly inform, communicate with, and educate patients; share decision making and management; and continuously advocate disease prevention, wellness, and promotion of healthy lifestyles, including a focus on population health.
Work in interdisciplinary teams – cooperate, collaborate, communicate, and integrate care in teams to ensure that care is continuous and reliable. Employ evidence-based practice – integrate best research with clinical expertise and patient values for optimum care, and participate in learning and research activities to the extent feasible. Apply quality improvement – identify errors and hazards in care; understand and implement basic safety design principles, such as standardization and simplification; continually understand and measure quality of care in terms of structure, process, and outcomes in relation to patient and community needs; and design and test interventions to change processes and systems of care, with the objective of improving quality. Utilize informatics – communicate, manage knowledge, mitigate error, and support decision making using information technology.
Educating nurses in EBP competencies was catapulted forward. While the materials presented were in existence in other professional literature, the book added great value by synthesizing what was known into one publication. This resource was accessible to every faculty member offering teaching strategies and learning resources for incorporating the IOM competencies into curricula across the nation. The resource continues to be updated and expanded. The strength of these resources is that the approaches and strategies remain closely aligned with the Institute of Medicine’s continuing progress toward better health care. This close alignment reflects the appreciation that nursing must be part of this solution to effect the desired changes; and remaining in the mainstream with other health professions.
Through this national research collaborative, rigorous studies are designed and conducted through investigative teams. Foundational to the network is the virtual collaboratory, fashioned to conduct multi-site studies and designed around inter-professional academic-practice partnerships in research. The ISRN offers. Research Priorities were developed via stakeholder and expert panel consensus and are organized into four broad categories: transitions in care; high performing clinical microsystems; evidence-based quality improvement; and organizational culture. The research collaboratory concept has proven its capacity to conduct multi-site studies and is open to any investigator or collaborator in the field.