After reading this article, you will be able to:
- Describe how Montgomery Regional Hospital (MRH) educated and inspired nurses about evidence-based practice
- Discuss the format used by MRH to hold a debate
- Identify the topics debated by MRH
by Lisa Wade, RNC, BSN, CTL
When nurses hear the word “research,” they often run in the opposite direction. Even the definition of evidence-based practice (EBP) can be intimidating for bedside nurses: “A practice that involves making clini- cal decisions on the best available evidence, with an emphasis on evidence from disciplined research” (Polit and Beck, 2008).
Nurses have a duty to be current in their practice to ensure best patient outcomes. In addition, one of the central focuses of the ANCC Magnet Recognition Program? (MRP) is that facilities follow evidence-based nursing practice.
Therefore, any hospital on the journey to MRP designation must ensure that its culture is focused on EBP and that nurses are engaged and excited. It was with this aim that Montgomery Regional Hospital (MRH) in Blacksburg, VA, tried an innovative debate format to educate and inspire its nurses.
Sowing the seeds of an idea
I attended the ANCC’s annual MRP conference in October 2008 in Salt Lake City and had the privilege of sitting in on many great informative sessions. I was particularly impressed with the session about how to engage staff nurses in EBP, presented by nurses from The University of Alabama. The session described how the hospital used a court and trial format to discuss EBP issues, which seemed engaging and fun.
This inspired me to start thinking about ways my facility could engage staff nurses. Although the court format was appealing, it would require approximately 15 people for the court, including a judge, a foreman, two attorneys, nine jurors, and two to four witnesses. This was a problem because Montgomery Regional is a much smaller facility than The University of Alabama, thereby limiting our personnel resources. I began to think of other fun ways to approach EBP education. I had recently watched the movie The Great Debaters and began to ponder the idea of debating the evidence.
I presented my idea to the research council, the professional practice council, and the nursing leadership council and received unanimous support to proceed with planning “MRH Nurses Debate the Evidence for Nurses Week 2009.”
Stirring the pot
One of the first steps was to identify a debate style to be used by those arguing their case. I performed a literature search and identified several styles: team policy, Lincoln-Douglas, National Debate Tournament, Cross Examination Debate Association, and Parliamentary. After thoroughly reviewing each style, I presented a summation of the styles to the three councils with a recommendation, which was accepted, that we use the team policy format because it is the oldest, and probably the most popular, of all debate formats.
In this format, two debaters speak in support of the topic, also known as the affirmative side, and two debaters speak against the topic, called the negative side. Each debater receives eight minutes to present his or her case. A speaker from the affirmative side presents first, followed by a speaker from the negative side, then the second affirmative speaker, and finally the last negative speaker.
Once everyone has presented, each debater gets another three- to four-minute slot for rebuttal, this time starting with a negative presenter, followed by an affirmative, and so on.
Three judges are required to hear the speeches and determine a winning side. In this format, only seven people are needed for a single debate session.
We decided to allot between one hour and one hour and a half for each session, which allowed for presentation time and a question-and-answer session with the audience. Because the time needed for presentation was much less than originally planned with the court format, we realized we could potentially present more topics.
Picking an argument
A call for hot topics was presented to each council, and the topics selected for debate were:
- Family presence during resuscitation
- Lidocaine administration prior to peripheral IV starts
- Preferential treatment for the aging workforce
The retention and recruitment council is responsible for the primary planning of Nurses Week activities, and a collaborative effort identified the best day to hold the debate. Once the day was chosen, we had to figure out what times during the day would enable the most people to attend. We considered change of shift, lunch, and afternoon lulls. We decided to start with family presence at 8 a.m., followed by lidocaine administration at 2 p.m. and the aging workforce at 5 p.m.
A hospitalwide e-mail was sent calling for volunteers to conduct the debate and announcing the topics of discussion. Debaters were asked to have interest in the topic and be willing to speak in front of a crowd but were not required to have any previous debate experience.
To reduce anxiety among those interested in debating, the research council performed literature searches on the chosen topics and provided volunteers with the resulting top three articles. Besides decreasing nerves, this ensured that each debater received the same literature for his or her selected topic. We also gave everyone the format and time expectations well in advance.
Since I was serving as the chair/moderator for the debates, I planned a group meeting the day before the scheduled debates to review the format and time limits, as well as to answer any questions in an effort to alleviate any lingering fears.
We created objectives for each session so the audience would have a guide to the expectations of the debates. A standard evaluation form was also presented so the audience could evaluate the sessions and provide suggestions for improvement. The first session was audiotaped for later transcription, and the remaining two sessions were videotaped for viewing by staff members who were unable to attend.
Let the debates begin
We recruited the same three judges for all sessions:
- Loressa Cole, RN, BSN, MBA, chief nursing officer
- Ellen Linkenhoker, RN, BSN, MSN, market MRP coordinator
- Kimberly F. Carter, PhD, RN, from Radford (VA) University, who serves as a research consultant at MRH
After listening to each debate, the judges felt each topic presented an opportunity for research at our facility.
Attendance was good and included areas of the hospital other than nursing. Each attendee was asked to complete an evaluation at the end of the session, in which we received written confirmation that the debate format worked to educate nurses and get them interested in EBP. Written comments included:
- “Great job! This definitely provided food for thought.”
- “The presenters were very well versed in their subject of choice.”
- “When I came in, I was thinking one way, but when I left, my thoughts had changed totally based on the information presented.”
- “Do we have to wait a whole year before we do this again?”
Outline for next time
The first “MRH Nurses Debate the Evidence for Nurses Week” was a huge success. Plans have already begun for a 2010 debate week; we intend to make improvements to next year’s discussion based on what we learned through our experience this year.
One lesson learned is the need for a timer. In one session, one of the presenters went over the allotted eight minutes and spoke for 20 minutes. Another consideration would be to hold a presentation practice session prior to the formal presentation day.
Although the injection of humor into the presentations created a lighter environment, it would be useful to have an opportunity to provide debaters with training on the appropriateness of humor in this type of presentation.
For next year, we may consider the possibility of presenting the information on more than one day.
Even though we used hospitalwide e-mail and word of mouth for advertising, we recognized the need for more in-depth advertising to generate excitement. Tying the debates into literature searches also provides opportunities for education on EBP.
Polit, D., and Beck, C. (2008). Nursing Research: Generating and Assessing Evidence for Nursing Practice, Eighth Edition. Philadelphia: Lippincott Williams and Wilkins.
Adapted from HCPro’s Advisor to the ANCC Magnet Recognition Program®, November 2009, HCPro, Inc.