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Welcome to our evidence-based practice resource center

Evidence-based practice (EBP) is becoming the standard in nursing and is a critical element to creating a culture of excellence among your staff. In our EBP resource center, you will find:

Timely articles on everything from implementing a quality EBP program at your facility to assessing and appraising your resources
Tools to help you overcome EBP barriers
Much, much more, including information on starting journal clubs, how and where to do the best research, and tips on keeping staff motivated

Implementing just-in-time training Free Download
The ability to train staff on a new technique at the drop of the hat is important in any facility. If not done correctly, it can cause upheaval in any efficient staff development program. Find out how to develop a training system to ensure that all staff members can communicate efficiently and effectively.

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Embed HAC prevention into your performance improvement plan
As a hospital seeks to proactively identify and reduce unanticipated safety risks to patients, its work on preventing hospital-acquired conditions (HACs) will naturally become an integral part of the organization’s performance improvement plan. The identification of HACs through data collection and analysis will provide guidance in prioritizing areas of focus for performance improvement in each of the conditions.

Moving from evidence to education: An EBP project takes flight
After identifying an increase in patient falls, Debbie Durant, RN, BSN, director of the med-surg unit at North Adams (MA) Regional Hospital, and Peg Daly, RN, BS, education specialist at the 120-bed hospital, joined forces to develop an evidence-based initiative to:
- Decrease falls by 10% within 12 months of plan implementation
- Review and revise falls policy and procedures based on evidence-based data
- Recommend necessary education for staff members
- Develop ongoing performance improvement monitoring

Caring for the aging population
By 2030, there will be more than 72 million Americans over 65 years old—almost 20% of the population (He et al., 2005). Are your nurses educated and prepared to care for them?

Prevent catheter-associated urinary tract infections
Catheter-associated urinary tract infections (CAUTI) are the most common of all hospital-acquired conditions (HAC). Eighty percent of UTIs result from indwelling urinary catheters, and 12%–16% of patients admitted to acute care hospitals may have indwelling urinary catheters at some point during their stay.

One of the best ways to reduce the risk of CAUTI is to reduce the use of catheters. So as the organization begins its journey, it must decide which patients truly need indwelling urinary catheters.

Performing functional assessments
One healthcare objective is to improve or maintain a patient’s functional abilities and overall quality of life. By performing a functional assessment, nurses can determine patients’ current level of functioning and plan care to improve it. This assessment should be included on the facility’s multidisciplinary initial patient assessment form. Use this functional assessment tool to ensure charting is complete.

Evaluate staff for emergency preparedness
Patient care permits little room for nurses to be anything but on their toes. And in the event of an emergency, the need for nurses to respond quickly and deliver competent patient care is magnified. This evidence-based checklist covers the steps nurses should take when responding to an emergency. Use it to evaluate your staff for emergency preparedness and make certain they have the skills to perform.

Fall assessment guidelines
To avert patient falls, hospitals should assess every patient for fall risk upon admission. And every time a fall occurs, that patient should be assessed again. Use this figure that examines elements that must be addressed during these assessments to prevent patient falls at your facility.

Analyzing your orientation program
Every facility has its own needs and culture, so assessing the effectiveness of your orientation program should be a priority. The following template can serve as a guide as you evaluate your facility’s teaching methods, generational learning strategies and calculate costs. Feel free to use and adapt these templates to help you to analyze and revise your orientation program.

Building your pressure ulcer team and program
Often, it is not until you feel the enormity of the task that you realize one policy and one person cannot do it alone. The pressure ulcer problem has far-reaching effects, and correcting it takes the talents of an entire team. A multitude of studies have shown the positive difference in outcomes that involve well-established teams.

Creating a pressure ulcer prevention program
To create an effective program for pressure ulcer prevention, you first need to conduct a risk assessment to identify risk factors, and then focus your prevention program on minimizing their negative effects. When addressing pressure ulcers as a risk-management problem, prevention is the number one solution. It alleviates needless patient suffering, unnecessary healthcare costs, and associated litigation.

Support surfaces for pressure ulcers
A cornerstone in reducing pressure is choosing support surfaces, such as pressure-reducing cushions, mattresses, and specialty beds or mattress-replacement systems. The intent of these products is to reduce "interface pressure," which is the force that acts between the body and the support surface and is primarily affected by the composition of the body tissue, the stiffness of the support surface, and characteristics of the patient’s body. However, despite the wide range of support-surface products available and the claims of all companies, few clinical trials have been conducted. Refer to this table for descriptions and categories of support surfaces.

Guiding patients through consumer health information
Going to the library used to be an adventure in books and other printed material. Doing research meant searching through the indexes to find the literature, exploring journal articles that were often in separate areas of the library, taking notes on index cards (especially in the days before readily accessible copiers), and finally waiting for weeks for an interlibrary loan request. Luckily, today many of the same resources are accessible with the click of a computer mouse. And though the digging process has been simplified, finding pertinent literature and research can still be a challenge.

Increase info retention with Technicolor
You might be training your staff about vital protocols and important regulations, but if your slides are saddled with black and white colors, you might be looking at an audience with glazed-over eyes.

Each generation has its own needs
There are four generations of learners currently working in the healthcare environment, each with different characteristics and learning preferences. Analyze your orientation program in terms of what you are doing to enhance the learning experiences of these generations and what you would like to do in the future.
This table is a generalization of predominant characteristics and learning preferences. Remember, however, that no one set of characteristics or preferences is common to all members of a specific generation.

Retaining experienced nurses
The Robert Wood Johnson Foundation (RWJF) is the nation's largest foundation devoted to improving health and healthcare, and one of its main focus areas is nursing. To reduce the effects of the country's increasing nursing shortage and improve the quality of patient care, RWJF identified a need to encourage experienced nurses to remain at the bedside, where their knowledge and leadership can be harnessed to deliver high-quality patient care and to train the next generation of nurses.

The new grad as the critical thinker
New graduates entering the nursing world may breathe a sigh of relief that their classes are done. But according to Shelley Cohen, RN, BS, CEN, and Kelly A. Goudreau, DSN, RN, CNS-BC, when it comes to critical-thinking skills, school is just getting started.

Increase nursing retention rates with evidence-based orientation program
Effective new employee orientations are crucial to ongoing job satisfaction and retention. Find out how a staff development professional created an evidence-based orientation program that transformed a 25%-30% retention rate for newly-hired nurses into an 80% retention rate after only three years.

Behavioral change and knowledge application during nursing orientation
The following template can be used during nursing orientation and offers suggestions for documenting the evaluation of behavior. The template allows for nurses to demonstrate skills and documentation to be evaluated separately. Note that both the evaluator and the nurse being evaluated must sign and date the form. Identifying objectives makes it clear to the nurse exactly what he or she must do to succeed.

Implementing staff development specialist competencies
Staff development specialists are responsible for developing clinical competency programs and assisting with their implementation. But what about assessing the competency of staff educators? Historically, there has been little research undertaken or published that deals with the competency of staff development specialists. This deficit inspired Barbara A. Brunt, MA, MN, RN-BC, director of nursing education and staff development at Summa Health System in Akron, OH, to conduct research for the purpose of identifying and implementing a competency program for staff educators.

Daily goals sheet for preventing catheter-associated urinary tract infections
Patients' need for continued catheterization should be assessed each day. Nurses can complete daily assessments using tools such as an evidence-based CAUTI daily goals sheet. This daily serves as a proactive approach for reducing catheter days and minimizing the risk of infection. Each day, the CAUTI daily goals sheet prompts nurses caring for patients with indwelling catheters to determine the appropriateness of continuing the catheter or selecting a catheter for continued use that is designed to reduce the risk of infection. If patients do not meet criteria established on initial or continued daily assessment or the rationale defined in the initial physician's order, nurses should obtain orders for the catheter to be removed.

Pain assessment tools
Assessment is best performed using reliable and valid pain assessment scales and tools. Here are examples of some of the more commonly used scales and tools for both acute and chronic pain.

Evidence-based practice: Educating nurses about fall prevention
After identifying an increase in patient falls, Debbie Durant, RN, BSN, director of the medical-surgical unit at North Adams (MA) Regional Hospital, and Peg Daly, RN, BS, education specialist at the 120-bed hospital, joined forces to develop an evidence-based initiative to: Decrease falls by 10% within 12 months of plan implementation Review and revise falls policy and procedures based on evidence-based data Recommend necessary education for staff members Develop ongoing performance improvement monitoring

Embed HAC prevention into your performance improvement plan
As a hospital seeks to proactively identify and reduce unanticipated safety risks to patients, its work on preventing hospital-acquired conditions (HACs) will naturally become an integral part of the organization’s performance improvement plan. The identification of HACs through data collection and analysis will provide guidance in prioritizing areas of focus for performance improvement in each of the conditions.

Moving from evidence to education: An EBP project takes flight
After identifying an increase in patient falls, Debbie Durant, RN, BSN, director of the med-surg unit at North Adams (MA) Regional Hospital, and Peg Daly, RN, BS, education specialist at the 120-bed hospital, joined forces to develop an evidence-based initiative to:
- Decrease falls by 10% within 12 months of plan implementation
- Review and revise falls policy and procedures based on evidence-based data
- Recommend necessary education for staff members
- Develop ongoing performance improvement monitoring

Train nurses to handle obese patients with sensitivity
Seeking healthcare should never be described as a constant battle or a struggle, but for overweight and obese patients, too often, these words best characterize their healthcare experience, according to a recent study in the Journal of Advanced Nursing.

Prevent friction and shear to minimize pressure ulcers
Friction usually, but not always, accompanies shear. Friction is the force of rubbing two surfaces against one another. Shear is the result of gravity pushing down on the patient’s body and the resistance between the patient and the chair or bed. When combined with gravity/force (pressure), friction causes shear, and the outcome can be more devastating than pressure alone. This figure highlights many of the common practices observed in healthcare facilities that contribute to friction and shear and alternatives for prevention.

No laughing matter: Clowns teach nurses valuable lessons
During their shifts, nurses travel their units, busily dispensing medication, checking IVs, and making sure patients have what they need to be comfortable. They speak with family members, give discharge instructions, and update physicians about patients’ conditions. But with all that they do, they often miss the thing patients need most: an emotional connection.

Falls are focus of community hospital's first EBP project
For reasons she can’t explain, Debbie Durant, RN, BSN, has seen a rise in the number of patient falls occurring recently at North Adams (MA) Regional Hospital. “Up until six months ago, our fall rate was pretty flat,” says Durant, director of the medical surgical unit at the 120-bed hospital. “But about six months ago, they began to jump, and we don’t know why."

The art of nursing
Developing your nurses’ assessment skills regarding changes in patients’ conditions is essential to ensuring they provide safe, effective care. With the recognition that assessment is an important part of healthcare and art, a Chicago hospital decided to team up with a local museum to develop a training program to improve this skill set among its new graduate nurses. “To improve assessment skills, we wanted to make this a more interactive program, not just put them in front of a PowerPoint,” says Randy Ball, RN, MSN, nurse educator in the center for professional practice and research at the University of Chicago Medical Center (UCMC).

Celebrate nurses without breaking the bank
Recognizing and rewarding nurses should not be an annual event during Nurses’ Week; it should be a part of every unit’s culture. But don’t fret about stretching your department’s meager budget. Many nurses enjoy receiving small gifts, such as movie tickets, scented lotions, or gift certificates.

Post-fall assessment/response "decision tree"
Every patient fall should lead to a reassessment of the patient in question by examining the cause of the fall and the interventions that were implemented. While the steps during a reassessment differ depending on the patient, this "decision tree" tool will guide staff through this critical process so that they are sure they know how to respond when a fall occurs.

Teach your nurses about time management
There never seem to be enough hours in the day for nurses. The ability to manage time and stay organized amid hectic schedules is crucial to staying stress-free and focused in the workplace, which will ultimately result in improved patient outcomes.

Strategies for wound pain management
Nurses must meet the challenge of assessing and managing their patients’ pain effectively as it is important for both the prevention and healing of pressure ulcers. The key to managing wound pain is to use a validated pain scale to regularly assess those patients with open wounds and pressure ulcers for pain. If the pain is frequent or constant, consider giving a scheduled pain medication.

Factors with the greatest influence on the nursing image
Find out what respondents of the image of nursing survey said was the one factor they would change that, in their opinion, has the greatest effect on the image of nursing.

Perspectives of the individual effect on the image of nursing
Read nurses' responses to a survey question regarding what individual nurses can do to help change and elevate the image of nursing.

Image of nursing survey results
The image of nursing continues to be an important and controversial topic. See how nurses across the country responded to a survey focusing on the current image of nursing and read individual nurses’ responses on what should be done to change their image.

Assess your culture for evidence-based practice
Every healthcare facility has a unique culture and approach to evidence-based practice, therefore evidence-based implementation should match this. By conducting an organizational assessment, you can survey nurses’ knowledge, attitudes, beliefs, and views regarding nursing research and evidence-based practice. Doing so allows you to establish the foundation for discussions and efforts related to evidence-based nursing practice.

Identifying learner characteristics
Many nurses are not aware of their learning styles, therefore can’t acquire information to their fullest potential. Because accelerated learning is most effective under conditions that are conducive to the learner’s knowledge acquisition, it is important to help your staff identify their learning preferences. Use this sample template to help your orientees (and other learners) understand what actions and activities best help them learn.

Step up nurse-patient interactions
by Deanna R. Miller, RN, MSN/Ed, HCE

My experiences as a hospital patient—in relation to nursing care—have never been negative. I received my medications on time, and the nurse came in each shift and assessed me. But what was lacking with my care was complete and effective patient education. Each day, as my nurse was performing an array of tasks, I often asked questions related to my stay and illness. Although the questions were answered appropriately, I felt as if it were a race with the clock as my eyes followed the nurse around the room as if she were a ping-pong ball.

Prepare your nurses for present-on-admission
Without involving your nurses in recognizing present-on-admission (POA) conditions, your hospital could be losing potential reimbursement and is not maximizing its opportunities to improve patient care. Lack of safety or compensation isn’t the only issue, as you want to ensure your facility is compliant with CMS regulations (which took effect October 1, 2007) requiring hospitals to report present-on-admission information.

Assessing competency for medication administration
Achieving safe, effective patient outcomes is every nurse’s goal when administering medication, but it takes experience that not every nurse has to always meet this goal. This evidence-based checklist lists the steps nurses should take when giving medication to a patient. Use this to evaluate competency in your staff members and ensure that your patients are delivered the safest care.

Creating a culture of evidence-based practice
For nurses to value and recognize the relevance and importance of evidence-based practice, they need ongoing support from the chief nurse executive and the nursing leadership team.The leadership team must encourage nurses’ efforts to question existing practice, have access to library resources and research experts, and provide time for nurses to work on evidence-based projects. Most importantly, the team must value clinical inquiry, scholarship, and questioning of the status quo.

New competency assessment checklist
It can be a struggle for nurses to achieve and maintain competency in complex procedures if they do not have regular opportunities to use such knowledge and skills. As a nurse manager, you may want to develop a policy that describes guidelines for new competency development (and for the deletion of competencies that are no longer necessary). This checklist may help you to document your assessment of the need for new competency development.

Preventing falls with effective exercise programs
Sufficient evidence states exercise reduces the risk of falling when included as part of a multifactorial intervention program. Exercises that develop postural balance control are the most successful, although strength and flexibility development provide adjunct benefits that may reduce injuries. Because impatient stays are generally brief, an exercise program is unrealistic. However, physical therapy and occupational therapy on a routine basis during an impatient stay can assist patients at risk and help them develop, maintain, or improve their postural balance control. Refer to this figure for a number of exercise studies and their resultant effects on participants’ fall rates.

Endeavoring into research
One goal of the research or evidence-based practice council might be to develop a policy or guidelines related to proposed nursing research efforts. The policy should include a purpose that addresses the importance of nursing research and evidence-based practice and contain clear guidelines on conducting research-specifically, it should outline procedures to protect the rights of human subjects. View this sample nursing research policy before starting any research project.

Recognize, reward, and retain at your organization
One of a hospital’s top priorities should be to retain competent nurses within its facility. According to the U.S. Bureau of Labor, hospitals will need more than 1.2 million replacement RNs by 2014. Maintaining an enjoyable, positive working environment is essential to nurse retention, and educators can take steps to ensure that their nurses are happy to be hired into—and stay at—their organization.

Creating internal expertise in evidence-based nursing
When administrative support is in place and nurses are becoming excited about undertaking projects and changing practice, start developing expertise about evidence-based practice. Initially, nurses could learn to navigate electronic databases and could investigate journals that are available in either print or electronic copy in their organization. If no journals or databases are available, the same outcome can be obtained by visiting a local hospital that is doing EBP and seeing what journals and electronic databases they have in place.

Boosting patient satisfaction
Striving to provide quality patient care is a goal at every healthcare facility. However, not every nurse recognizes the small steps they can take to deliver it. By remembering the three C’s: care, concern, and communication, nurses can improve patient satisfaction. The following checklist comprises simple, yet key, techniques nurses should practice whenever they come in contact with a patient.

Pain management: Educate to alleviate
Nurses want to provide patients with safe, comfortable care so that they don’t have to bear unnecessary pain. However, "nursing research is rich with examples of patients receiving substandard pain management and sparse individualized education," according to an article in MEDSURG Nursing. Train your nurses on pain management and give them the tools and motivation they need to manage discomfort because the absence of pain management education can be far-reaching.

Treatment concepts for pressure ulcers
There is a tremendous amount of literature and many seminars that cover pressure ulcer management and treatment, but the overall goal of treatment is rarely emphasized or even discussed. This omission likely stems from a tendency to focus thought processes on the wound itself. Before developing a treatment plan for pressure ulcers, make sure you understand some basic concepts. Treatment does not refer only to a topical approach to the wound; it involves the total interdisciplinary approach. Where do you start?

Evaluating research proposals
One of a nursing research council’s roles is to perform a peer review for nursing research study proposals. Peer review not only provides the benefit of different perspectives, but in the process of gaining those perspectives, the researcher can strengthen the proposal. The council/committee should develop the criteria they will use in their review and provide them to nurse researchers ahead of time.

Expert advice for choosing equipment
With a sundry assortment of hospital technology coming to the forefront of nurse training, educators must recognize the benefits (and potential downfalls) of available tools as they make practical choices with the goal of improving patient safety. "I suspect most of you are in the midst of the explosion of information technology [IT] in your organizations," says Diane M. Billings, EdD, RN, FAAN, Chancellors’ Professor Emeritus of Nursing at the Indiana University School of Nursing (IUSON) in Indianapolis, during the recent HCPro audioconference "Technology in Nursing Education: Use Today’s Tools to Promote Learning and Enhance Patient Safety."

Critiquing research articles
Once nurses decide they want to form a journal club, they often wonder how to begin critiquing a research article. The overall goal of a research critique is to evaluate a study's merits and its applicability to clinical practice. A research critique goes beyond a review or summary of a study, and it carefully appraises a study's strengths and limitations. This table consisting of 10 questions and practice exercises will serve as effective tools towards evaluating a study's component parts.

Prep for evidence-based nursing with a journal club
Creating a journal club is a good way to get started in evidence-based nursing practice. Journal clubs provide nurses with the opportunity and skills to read and critically evaluate current research and to determine its applicability to their practice area. Use the following information to help you get your evidence-based nursing practice off the ground.

Hey, doc, can we talk?
The sticky aspects of communication between nurses and physicians have existed for decades, and the problems seem ingrained in hospital culture. However, generational shifts and respectful attitudes being emphasized by new, fresh-faced physicians may be changing the dynamic of perhaps the most troublesome area of healthcare interactions. "It's an age-old problem that's been around for a very long time," says Marjorie Chavez, BS, RN, director of learning and development for CHRISTUS Spohn Health System in Corpus Christi, TX. "Historically, you have the doctor as kind of the boss, and the worker as subordinate. But I think it's much improved [from] a few years ago. Any culture change within a hospital will take a good long while."

Take a big step toward falls prevention
With patient safety at the forefront and the new Centers for Medicare & Medicaid Services ruling, which takes effect in October, stating Medicare will not pay for treatment of injuries resulting from preventable patient falls, staff educators are looking for quick, effective strategies to reduce fall rates at their hospitals and keep all of their patients safe from injuries. "Every hospital should have a falls prevention plan," says Shirley Frost, RN, MSN, director of education at Berlin (WI) Memorial Hospital.

Cultivate charge nurses at your facility
As the baby boomer generation of nurses heads for the door and younger workers begin to take charge, preparing your staff members for the leadership role of a charge nurse can appear daunting. However, when you determine what’s involved in developing charge nurses, this aspect of succession planning can prove exciting and highly beneficial to your organization.

Falls prevention problem list
An assessment of a patient’s fall risk is critical to delivering the best nursing care. The goal of performing a screening assessment and developing a plan of care is to improve outcomes for the patient. What the clinician does or does not notice, teach, act on, report, or intervene upon greatly affects patient outcomes. The clinician determines what kind of care is required to meet the patient’s needs by conducting an appropriate assessment. Some patients only require care that is of a routine nature. This care can be provided entirely through the use of protocols/standards of care or practice guidelines. Figure 2.2 is an example of a tool that can be used to document the care provided through protocols.

A vision of staff satisfaction: Retain your nurses with these three steps
With an onslaught of administrative duties for nurse managers, you may discover the bulk of your precious time is spent away from where you're needed most: on the unit with your staff. Too many demands and too little time to devote to staff needs and performance often result in frustration for all involved, as was the case for medical division managers at The Reading Hospital and Medical Center in Reading, PA. Recognizing the critical need to promote staff satisfaction and improve retention, the 750-bed facility developed a three-step nurse retention strategy that focused on time reprioritization, forced ranking, and job sculpting.

Assessment of wound healing
Conduct regular and systematic wound assessments, and seize every opportunity to improve your patient's potential to heal. Wound assessment and management is only fractionally addressed by selecting the most effective topical treatment. If you try only to manage the pressure ulcer, you cheat your patient of the collective wisdom of the team and will be unable to ensure the most effective outcomes possible. There is a theme here that you must embrace: Pressure ulcer prevention and management are multifaceted and cannot be conducted in a bubble. Assessment of wound healing requires the same interdisciplinary approach. Although dimensions are very important descriptors, assessment cannot be conducted by measurement alone.

Orientation Surveys
Obtaining accurate data from orientation surveys is problematic. It is imperative that data be colleted concerning staff development services, preceptor action, and managerial actions. It is not enough to simply evaluate the performance of the orientee. How he or she was treated and the effectiveness of orientation, including the effectiveness of the preceptor and manager, all contribute to retention and job satisfaction. The sample tool (Figure 11.1) offers suggestions for developing an evaluation tool for orientees to complete.

Role-play to promote comfort in discussing end-of-life decisions
The first difficult discussion a nurse has regarding end-of-life decisions should not occur under stress when a terminally ill patient is pressing the nurse for assistance. Therefore, as part of the educational process, nurses should role-play various case scenarios with one another regarding how to address end-of-life issues and discussions appropriately. The intent of this role-play activity is to increase nurses' comfort levels in discussing advance directives.

Get your evidence-based program off the ground sooner than you think
A quick poll during HCPro's recent audioconference "Applying Evidence-Based Nursing: Successful approaches to Data-Driven Practice" revealed some intriguing numbers. Listeners were asked where they were in their quest to bring evidence-based practice (EBP)-using the current best evidence to make decisions about the care of patients-to their facilities.

Up, up, and away! Clinical ladders offer opportunities for staff RNs
It was not too long ago that bedside nurses were rewarded for their ex-ceptional skills and the high-quality care they provided to their patients by progressing in their careers to management positions-which then took their skills away from the bedside. To rectify this, many facilities designed career development opportunities for nurses who wanted to stay at the bedside.

Developing a time to work and a time to play
Using games in the clinical setting has become popular in many facilities as a fun-and effective-training technique. Whether they are teaching facts about a particular patient affliction or coaching on critical thinking skills, games have become a proven strategy to relay information in a clinical classroom.

Can you really teach courses online?
It used to be that teaching a class meant standing in front of your students, lecturing from your handwritten notes while scribbling on a blackboard. Although that is still the preferred method of many educators, the benefits of teaching a course online are catching on.

Are there not enough hours in the day?
It's a question asked by new and experienced nurses alike: when the list of to-dos seems insurmountable, how should valuable time be managed? A time-sensitive clinical setting leaves little room for wasted minutes, and with staffing numbers taking a hit at many facilities, nurses need to learn how to best utilize the workday.

Group work: Implement evidence-based practice with these simple tips
Evidence-based practice (EBP) helps nurses provide high-quality patient care based on research and knowledge rather than because "this is the way we have always done it," or based on traditions, myths, hunches, advice of colleagues, or outdated textbooks. Among other improvements, EBP results in better patient outcomes, contributes to the science of nursing, keeps practice current and relevant, and increases confidence in decision-making.

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