Professional Documents
Culture Documents
Future of Nursing
The Evolution of
Evidence-Based Practice
What is - Evidence?
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67 83
35 47 51
25
0 0 0 1 0 0 5
'91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04
2011 – Medline search > 38,000
Within one decade, the concept of
evidence-based practice has
evolved and been embraced by
nurses in nearly every clinical
specialty, across a variety of roles
and positions, and in locations
around the globe.
• Risk-taking environment
Nursing vs. Medical Questions
• What else?
What kind of questions might the
Nurse Manager ask?
• Government agencies
• Cochrane Collaboration
• Professional Organizations
• Benchmark Institutions
AHRQ – Agency for Healthcare
Research and Quality
Cochrane Collaboration
• AACN
• AWHONN
• AORN
• ONS
• Sigma Theta Tau
Am. Assoc. of Critical Care Nurses
• Strategic Plan
• Online Resources
– NKI http://www.nursingknowledge.org > 200
resources for EBP – some free, some for purchase
• New Award for EBP (formerly Clin Scholarship)
• Conferences
– International EBP and Research Congress
– July, 2010 – Orlando
– July, 2011 – Cancun
– July, 2012 – Australia
Journals Supporting EBP
– Evidence-Based Nursing
– Online Journal of Clinical Innovations
– WorldViews on Evidence-Based Nursing
– The Online Journal of Knowledge Synthesis for
Nursing – (archived, no longer being published)
– Reflections on Nursing Leadership (Vol 28, 2)
Local vs. Global Evidence
• Yet this good care was not best for me. It wouldn’t give me
health. Instead, it might take away what health I had. It
doesn’t matter if care is cutting-edge, technologically
advanced, (and evidence-based); if it doesn’t take the
patient’s goals into account, it may not be worth doing.
• I returned to my original New York oncologist.
59
Center to Champion Nursing in
America http://championnursing.org
• Center to Champion Nursing in America is an initiative of AARP, the
AARP Foundation and the Robert Wood Johnson Foundation. The
Center, a consumer-driven, national force for change, works to
increase the nation’s capacity to educate and retain nurses who are
prepared and empowered to positively impact health care access,
quality, and costs.
Nursing has an unprecedented
opportunity to have one voice on behalf
of patient care…
• 18 member committee
– Donna E. Shalala (Chair), President, University of Miami
– Linda Burns Bolton (Vice Chair), Vice President and
Chief Nursing Officer, Cedars-Sinai Health
• Evidence based
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Provide Patient-
Utilize
Centered
Informatics Care
“Work in
Interprofessional
Teams”
Core
Competencies
Employ Evidence-
Based Apply Quality
Practice Improvement
RECOMMENDATION NO. 1
65
The many faces of advanced practice
registered nurses in 2011
High
quality,
safe,
affordable
health care
provided by
teams of
health care
professionals
Health care reform
• Survey published in JAMA 2008, only 2% fourth-
year medical students plan to work in general
internal medicine (primary care) after graduation,
despite need for 40% increase in number of
primary care physicians in the U.S. by 2020
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National barriers
Medicare now
– Allows NPs to serve as the attending for a
hospice patient
– Allows Governors of states to opt out of
supervision rule for CRNAs – 16 states
have opted out
– Reimburses CNMs at 100%
“Messaging”
RECOMMENDATION NO. 3
New
graduates and
nurses in
transition
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The Problem – Transition to
Practice: Promoting Public Safety
RECOMMENDATION NO. 4
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Rationale (Institute of Medicine, 2011, p. 169-170)
“Several studies support significant
association between educational level of RN
and outcomes for patients in acute care
settings, including mortality”
79
Enrollments increasing in both DNP
and PhD programs (1997-2009)
RECOMMENDATION NO. 6
81
Faculty partner with health
care organizations
• Develop and prioritize competencies so
curricula updated regularly across all
programs
– go beyond task-based proficiencies to higher-
level competencies
• demonstrate mastery over care management
knowledge domains
• provide foundation decision-making skills under
variety clinical situations across care settings
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Academic administrators
83
Health care organizations and
schools of nursing
• Foster culture of lifelong learning
• Provide resources for interprofessional
continuing competency programs
• If offer continuing competency programs,
regularly evaluate for flexibility,
accessibility, and impact on clinical
outcomes
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Institute of Medicine October 2010 Report: The
Future of Nursing Leading Change, Advancing
Health