Although nurses strive to promote evidence-based interventions, many practices and beliefs persist despite limited research to support them. During a session on Wednesday, April 10, 2019, at the ONS 44th Annual Congress in Anaheim, CA, Nancy Houlihan, MA, AOCN®, of Memorial Sloan Kettering Cancer Center in New York, NY, Lynn Gallagher-Ford, PhD, RN, NE-BC, DPFNAP, FAAN, of Ohio State University, Helene Fuld Health Trust, National Institute for Evidence-Based Practice in Nursing and Healthcare, in Columbus, and Suzanne Dixon, MPH, MS, RD, of No Nutrition Fear in Portland, OR, instructed nurses on how to be myth busters in oncology practice settings.
Cultivate a Spirit of Inquiry
Evidence-based practice (EBP) is the integration of best research combined with clinical expertise and patients’ preferences to make conscientious healthcare decisions. Gallagher-Ford and Houlihan discussed how change begins by assessing whether an organization is ready for EBP. In many settings, a common rationale is ,“Because we’ve always done in that way.” Houlihan advised nurses to counter this by fostering a spirit of inquiry.
“Building a culture first requires competence in EBP process,” Houlihan said. “Gaining knowledge and skills in performing EBP and demonstrating value to an organization's leadership can gain support. Positive patient outcomes, value, and return-on-investment measurement are hard for resistors to deny.”
Ask the Right Questions With PICOT
Once an organization recognizes the value of EBP, nurses can formulate a search strategy by asking PICOT questions:
- P = Population/problem
- I = Intervention/issue of interest
- C = Comparison
- O = Outcomes of interest
- T = Timeframe (when applicable)
For example, a medical surgical unit seeking to reduce the rate of urinary tract infections in patients with catheters may populate their PICOT with the following:
- P = “Hospitalized adults”
- I = “Nurse-driven protocol”
- C = “Physician-ordered catheter removal”
- O = “Catheter-associated urinary tract infection rates”
- T = “During hospitalization”
The final formulated question would then be: “In hospitalized adults, how does a nurse-driven protocol compared to physician-ordered catheter removal affect catheter-associated urinary tract infection rates during hospitalization?”
Once a PICOT question is formed, keywords are used to search databases. Gallagher-Ford and Houlihan recommended that nurses enlist their librarian to help perform a robust search. Strategies include using multiple databases, combining search terms with Boolean operators (e.g., “AND,” “OR”), and applying limits (e.g., English language, age groups). After obtaining and synthesizing strong evidence, nurses can implement and measure EBP recommendations.
Overall, Houlihan said that nurses can do away with interventions that lack evidence by conducting diligent research, measuring outcomes, and disseminating successes. In addition, nurses can seek help from others in their organization who support practice change.
“Write a PICOT question, and review and synthesize the evidence on a clinical issue,” Houlihan said. “Gather internal evidence related to current outcomes. Present it to key stakeholders to influence practice change and identify metrics. Find the early adopters in your organization. People need to be shown and, while there are always naysayers no matter what, early adopters will assist.”