Strengthen a Commitment to Practice Change Through EBP Immersions
That “science, informatics, incentives, and culture are aligned for continuous improvement and innovation” in care delivery through evidence-based practice (EBP) that uses research outcomes, clinical expert perspectives, and patient and family engagement, the National Academy of Medicine Roundtable on Value and Science-Driven Health Care project charter visualizes (http://www.nationalacademies.org/hmd/~/media/Files/Activity%20Files/Quality/VSRT/Core%20Documents/CharterandVision.pdf).
By 2020, the goal is to ensure that 90% of clinical decisions are individualized yet supported by the most current, relevant, and best-available evidence and effective tools are in place to measure outcomes.
A commitment to EBP is also a required component of various accreditation processes. The Magnet or Pathway to Excellence designation through the American Nurses Credentialing Center (http://www.nursecredentialing.org/Pathway/AboutPathway/PathwayPracticeStandards) involves demonstrating the application of existing evidence to care processes and the use of new evidence to support professional development. The Joint Commission National Patient Safety Goals (https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2017.pdf) and accreditation standards include expectations that care interventions are evidence-based. Specific to oncology, settings accredited by the American College of Surgeons Commission on Cancer must comply with evidence-based cancer prevention, treatment, and care intervention guidelines as outlined in the Cancer Program Standards.
To meet these goals and standards expectations, many organizations establish an EBP mentorship or fellowship program (http://onlinelibrary.wiley.com/doi/10.1111/wvn.12032/full) that includes an immersion process. The benefits of investing in intense EBP training are becoming more evident in the literature, including a study that described the empowerment of nursing staff (http://journals.lww.com/jnsdonline/Abstract/2016/01000/Immersion_in_Evidence_Based_Practice_Fellowship.4.aspx) with knowledge and skills to embrace practice change after being immersed in a year-long EBP fellowship. Immersion programs are intended to build on participants’ existing level of EBP knowledge and expertise. However, underlying organizational and unit-based commitment to EBP are essential adjuncts to the immersion experience, and successful outcomes necessitate leadership support, elimination of practice change barriers, and regular opportunities for facilitating, implementing, evaluating, and sustaining EBP.
Immersive EBP Programs
When seeking to develop an internal EBP immersion or fellowship program, many organizations start by consulting experts in EBP program development and opting for leaders and clinicians to participate in immersion opportunities. The most commonly cited immersions are structured as hybrid programs. Participating clinicians become institutional champions for practice change as EBP fellows or mentors.
The Ohio State University Helene Fuld Health Trust National Institute (https://fuld.nursing.osu.edu/) for EBP in Nursing and Healthcare offers an online, self-paced introductory EBP course and also holds five-day immersion programs at the Columbus campus that include an intensive, mentored step-by-step education process and strategies for clinicians to develop EBP skills. The program also offers guidance to build the needed infrastructure for a sustainable EBP program. Individual and institutional follow-up are provided to maintain momentum for EBP.
The Johns Hopkins Nursing Center for Evidence-Based Practice (http://www.hopkinsmedicine.org/evidence-based-practice/index.html) also offers a self-paced online course and video series, along with intensive five-day boot camp workshops in Baltimore, MD, preparing participants to conduct an EBP project. Expert consultation to assist organizations in assessing EBP needs and developing EBP goals and strategies is also available. The center’s website highlights exemplar projects and provides accessible EBP resources.
These well-established and multifaceted immersion programs consist of intensive training with access to EBP experts, online resources, and follow-up support to ensure ongoing skill building for clinicians and engagement of leaders. EBP immersion programs strengthen the use of evidence and improve patient outcomes by helping nurses and other healthcare professionals learn the essential steps in the EBP process. Developing an EBP culture enhances nurses’ ability to engage in scholarly activities for project implementation and dissemination in the workplace.