INR Features

Research continually updates nursing knowledge on how to deliver care and improve patient outcomes. Findings from research studies validate the merit of current practice and provide the basis for initiating practice changes. Utilization of research findings improves the quality and cost-effectiveness of patient care and advances the science of the nursing profession.

Over the past decade, there have been systematic efforts to synthesis existing evidence to help bridge the gap between research findings and clinical practice. Examples of these efforts include the On-line Journal of Nursing Synthesis which provides systematic reviews on practice related topics, the Cochrane Database of Systematic Reviews which offers thorough, detailed descriptions of studies conducted and findings on specific aspects of care, and the development and dissemination by government and professional organizations of evidence-based practice guidelines to provide direction to practicing nurses and other health care professionals. Recently, the Agency for Healthcare Research and Quality (AHRQ) published a review of systems to rate the strength of scientific evidence (AHRQ, 2002). This report proposes standardized methods for rating evidence and determining if a sufficient research base exists to drive practice. Today, meta-analytic techniques are also being used whenever possible to quantitatively synthesis data from randomized controlled trials and multi-site studies are being funded to gain clearer insights into the truth regarding the effect of practice interventions. The strength of evidence on select topics is, in fact, so high that not changing practice to comply with the evidence can place institutions and practitioners at risk for negligence in courts of law.

It is, therefore, important that health care institutions implement mechanisms to infuse available evidence into the practice environment to maintain a level of care that is competent and appropriate. Various models exist for doing this, such as the CURN, WICHE, Stetler, and Iowa models. A widely used model is the Iowa Model of Evidence-Based Practice to Promote Quality Care (Titler, et al, 2001). This model was developed and implemented at the University of Iowa Hospitals and Clinics (UIHC) and has been used by nurses around the world to identify areas of clinical inquiry (problem- and knowledge-focused triggers) that may be addressed through synthesis and application of research findings. For example, critical care nurses in Hong Kong used the model to guide changes in practice regarding normal saline instillation before suctioning ventilated patients (Taylor-Piliae, 1999). No adverse outcomes arose from withholding normal saline before suctioning and a decrease in nosocomial respiratory infection and improvements in patient comfort were noted. Staff were satisfied with the change in practice and a significant cost savings was realized. The model has also been used to reduce restraint use in the acute care setting (Cruz, Abdul-Hamid, & Heater, 1997) and promote early ambulation after cardiac catheterization, resulting in improved patient comfort, higher patient satisfaction, and significant cost savings without adverse outcomes (Lundin, Sargent, & Burke, 1998). Various other efforts are assisting nursing leaders, administrators, and clinicians to infuse research findings into practice. For example, the AHRQ is funding translational research with the goal of providing evidence on effective strategies for infusing evidence into the practice environment. A multi-site study From Book to Bedside: Acute Pain Management (RO1HS10482) was recently conducted by Marita Titler, RN, PhD, FAAN and Keela Herr, RN, PhD at the University of Iowa using sites from across the state of Iowa to test strategies using change champions, opinion leaders, and organizational structures to infuse practice changes.

Educational opportunities are also increasing for nurses interested in learning about the process of evidence-based practice. Conferences, such as the National Evidence-Based Practice Conference held annually at the University of Iowa, are being offered across the country to assist nurses in identifying areas where the evidence supports a change in practice and facilitate implementation of systems to infuse evidence into clinical settings. Schools of nursing are refocusing research courses in baccalaureate and masters programs to include the process of critiquing and utilizing research findings. Web-sites are also being designed for nurses and other healthcare practitioners to learn how to implement evidence-based practices.

By using research, nurses commit themselves to the process of continuously evaluating and improving the quality of patient care they deliver. Only through this process can nurses significantly impact patient outcomes and demonstrate the effectiveness of their services.

References

Cruz, V., Abdul-Hamid, M., Heater, B. (1997). Research-based practice: Reducing restraints in an acute care setting-phase 1. Journal of Gerontological Nursing, 23, 31-40.

Lundin, L., Sargent, T., Burke, L.J. (1998). Research utilization and improvement in outcomes after diagnostic cardiac catheterization. Critical Care Nurse, 18, 30-39.

Taylor-Piliae, R.E. (1999). Utilization of the Iowa Model in establishing evidence-based nursing practice. Intensive and Critical Care Nursing, 15, 357-362.

Titler, M.G., Kleiber, C., Steelman, V.J., Rakel, B.A., Budreau, G., Everett, L.Q., et al. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care. Critical Care Nursing Clinics of North America, 13, 497-509.

U.S. Department of Health and Human Services. (2002). Systems to Rate the Strength of Scientific Evidence (AHRQ Publication No. 02-E015). Silver Spring, MD: Author.

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