EVIDENCE-BASEDPRACTICEINTEGRATIONACROSSHAWAI`I’S

ACADEMICINSTITUTIONSKatherineFinnDavis, PhD,APRN,CPNP

AssociateDirectorofEvidenceBasedPracticeHawai`iStateCenterforNursing

kfdavis@hawaii.edu

CarolynDennison,MA,MLIS,AHIPScience&TechnologyLibrarianUniversityofHawai`iatManoa

cdenniso@hawaii.edu

Objectives

• Describethecreationofastate-wideevidence-basedprogramtointegrateEBPintoundergraduatecurricula• Delineatespecificapproachesidentifiedbyeducatorstofacilitateacademicintegration

DRIVERSFORCURRICULUMINTEGRATIONOFEBPClinical&Academic

ClinicalDriversforEBP• Federalagencies&bodies• AHRQ,DHHS,CMMS,NIH

• Accreditation&awards• JointCommission:StandardsandNationalPatientSafetyGoals

• BeaconAward,Magnet® Recognition,etc.• Otherorganizations• QualityandSafetyEducationinNursing(QSEN)Institute• NationalAcademyofMedicine

• Repeatedlyshowntoimproveoutcomes

AcademicDriversforEBP

• AmericanAssociationofCollegesofNursing(AACN)– BaccalaureateEssentialsIII(2008):ScholarshipforEBP– Master’sEssentialsIV(2011):Translatingandintegratingscholarshipintopractice

– DNPEssentialsIII(2006):Clinicalscholarship&analyticalmethodsforEBP

• Employers• QSENpublishedcompetencies:Pre-licensureandGraduate

BottomLine• EBPisnolongeraluxury– Butanecessity–Withincreasingaccountability– Andpossibleliabilityinthefuture

• Academiciansareresponsible toensuregraduatesarecompetentinEBP• So,what’sanacademiciantodo?

– BecomeacompetentpractitionerofEBP– SystematicallyintegrateEBPcontentintocurriculum

BecomeaCompetentPractitionerofEBPNecessaryskillstoperformevidence-basedpractice

BasicEBPSkills• DifferentiateEBPfromresearchandqualityimprovement• Identifyaproblem&writeaPICOstatement• Developliteraturesearchskills:Searchselecteddatabasesandresourcesandadjustsearchstrategies• Critiquetheliterature

• Knowdifferentgradingcriteria&correspondinglevelsofevidence• Synthesizetheliterature

• Distinguishfromanannotatedbibliographyorliteraturereview• UseExceltoorganizebodyofevidence;useofsubtopics

• Makepracticerecommendations• Define&discusstranslationscience

• Implementationstrategies• Evaluationstrategies

SystematicallyIntegrateEBPContentintoCurriculumUsing an EBP model

ConceptualModelforEBP

The Iowa Model

PedagogicalStrategiesforEBP

1. Triggers– DriversforEBP:Clinicalandacademic– SporadicEBPcontent

• Somestudentsreceivednone;othersreceivedmore2. FormaTeam– EBPContentExpert– Librarian– CourseCoordinators

3.AssembleRelevantResearch

• PubMed (TeachingEBPANDNurs)• 120Articles• Limitedto:

• Humans• Publishedinpast5years• Research&SystematicReviews

• 47Articles• TeachingStrategies

• 9ArticlesScreened

• 5Articles

• LibrarianSearch• 9Articles• 1Overlapped• 8Articles

• Otherliterature• 9Articles• 3Textbooks

4. Critique&SynthesizeResearch• 9of22 articleswereaboutdifferentstrategiestoteach

critiquingskills(2 LevelIII,7LevelVI)

• Coursesandworkshopsdemonstratedimprovementsinknowledge,attitudes,&skillsofundergraduatenursingstudents(Davidson,2016,LevelIII;Zhang,2012;LevelIII)

• Student-staff-facultypartnershipswereutilizedtofacilitatelearningaboutEBP(Balakas,2010;LevelVI;Moch 2010,LevelVI;Schreiner,2015,LevelVI)

Non-researchbasedGeneralPedagogicalStrategies• Smalldoses,overtime• Simpletocomplex• Integrateintoeverycourse• Problem-basedlearning• Emphasizerelevanceto• Practice• Clinicalproblems

ExampleLearningActivities

• Gamingplatforms• Appraisingevidencegame• Debates• Casestudies• EBProunds• Journalclubs

• Oneburningquestion• Buildingblocks• Gradeliteraturesearches

5.IsThereaSufficientEvidenceBase?

• Isitenoughtomakepracticechanges?• Quality,quantity,&consistencyoffindings• Feasibility• Relevanceofresearchfindingsforteaching• Individualstudent&facultycircumstances,values,preferences

• Risk/benefitratio

5.PilotthePracticeChange• Three-daystatewideEBPEducatorworkshop

• 50nurseeducators• Sevenofthestate’snineschoolsofnursingwererepresented

• Curriculumdesign• StepsofIowaModel

• Onestepeachsemester• Pedagogy

• Spiraled/Leveled/Folded• Teachingstrategies

6.InstitutethePracticeChange• UniversityofHawai`iat Mānoa BaccalaureateProgram

• IowaModel– 7steps, 9classesover6semesters• CoursesmappedtoAACNEssentialsforBaccalaureateEducation,stepsofEBP,&relatedinformationliteracyskills• Metwithleadfacultyofeachcourse

• Refinedcontentforeachcourse• Packagedcoursematerials• Assistedwithlectures,asneeded

• Resourcessharedamongstallfaculty• BeganimplementationwithFall2016Sophomores

Curriculum mapCourse Sem

BaccEssentials

III

IowaModelPhase

EBPContent(spiral/level/foldthroughout) InformationLiteracy Course

Packaging

N211:Professionalism Fall AOC 1IntroduceEBP&InformationLiteracyCompetencies;DifferentiatePI,EBP,

Research(definingterms)

SearchTerms,CredibilityofResources,NationalGuidelines Sept

N210:HealthPromotionAcross

LifespanFall 1 EBP&TheIowaModel SummarizeanArticle

(250words) Oct

N220:Med-Surg I Spring 2 Triggers,Priorities,&Teams LevelsofEvidence,FindingFilteredInformation Jan

N320:OB/Peds(WI) Fall 2 PICO&PurposeStatements MESHTerms,WriteAnnotated

Bibliography Jan

N360:Med-Surg II Spring 3 AssembletheLiterature SearchMed-Surg Topic,WriteAnnotatedBibliography Jan

N363:Research(ETH) Spring 4 Critique&SynthesizeLiterature

Retrieve&AppraiseUnfilteredLiterature,GroupbyDesign,

SynthesizeJan

N450:Community(OC,WI) Fall 5

PilotingthePracticeChange(didactic-module);PICO&Critique/SynthesizeLiteratureforPublicHealthIssue

RetrievePublicHealthResources Feb

N465:Psych/MentalHealth Fall 6

InstitutethePracticeChange(didactic-module);PICO&Critique/SynthesizeLiteratureforMentalHealthIssue

Retrieve,Appraise,&Synthesize.Recommend

PracticeChangeMar

N460:ComplexNursing&Leadership

(WI)Spring 7 MonitorandAnalyzeStructure,Process,

andOutcomeData(didactic-module)

Retrieve,Appraise,&Synthesize.Recommend

PracticeChangeApr

7.EvaluatethePracticeChange

• Multiplerequestsfromacrossstateforanotherworkshop

• EBPChampions– Representativesfromeachschoolmeetquarterly– PlantoserveasfacultyatnextEducatorsWorkshop– OtherschoolshavealsobeguntointegrateEBPintotheircurriculum(UGandGraduate)

Conclusion:EBPisnotaluxury,itisanecessityforallnurses• EBPisnowintegratedintoclinicalandacademicqualitydrivers• AcademiciansneedtogainknowledgeandskillstobeeffectiveeducatorsofEBP• IntegratingtheEBPprocessintocurriculumisafeasibleapproachtoeducatenursingstudents• StatewideintegrationofEBPattheeducatorandcurriculumlevelispossible(andstillaworkinprogress!)

References• Balakas,K.,&Sparks,L.(2010).Teachingresearchandevidence-basedpracticeusingaservice-learning

approach.JournalofNursingEducation,49(12),691-695.doi:10.3928/01484834-20100831-07• Davidson,S.J.,&Candy,L.(2016).TeachingEBPUsingGame-BasedLearning:ImprovingtheStudent

Experience.WorldviewsonEvidence-BasedNursing,13(4),285-293.doi:10.1111/wvn.12152• Moch,S.D.,&Cronje,R.J.(2010).PartII.Empoweringgrassrootsevidence-basedpractice:acurricularmodel

tofosterundergraduatestudent-enabledpracticechange.JournalofProfessionalNursing:OfficialJournaloftheAmericanAssociationofCollegesofNursing,26(1),14-22.doi:10.1016/j.profnurs.2009.03.003

• Moch,S.D.,Cronje,R.J.,&Branson,J.(2010).Part1.Undergraduatenursingevidence-basedpracticeeducation:envisioningtheroleofstudents.JournalofProfessionalNursing:OfficialJournaloftheAmericanAssociationofCollegesofNursing,26(1),5-13.doi:10.1016/j.profnurs.2009.01.015

• Schreiner,M.,Kudrna,B.,&Kenney,C.(2015).HowundergraduatestudentscancontributetoEBP.NursingManagement,46(9),21-23.doi:10.1097/01.NUMA.0000470777.48225.b5

• Zhang,Q.,Zeng,T.,Chen,Y.,&Li,X.(2012).Assistingundergraduatenursingstudentstolearnevidence-basedpracticethroughself-directedlearningandworkshopstrategiesduringclinicalpracticum.NurseEducationToday,32(5),570-575.doi:10.1016/j.nedt.2011.05.018

LauraReichhardt,MS,APRN,NP-CAmyOno

DebraMark,PhD,RN,FAANMarita Titler,PhD,RN,FAAN