Evidence-Based Practice, Research, & Quality Improvement: APNs' Role

Introduction

Efforts to improve patient outcome as well as cut on the costs has led to the adoption of Evidence-Based Practice (EBP) in various cadres of healthcare. Nurses, especially Advanced Practice Nurses (APNs), are increasingly being involved in the development of knowledge, innovations, as well as improvements targeted at improving patient outcomes. This paper seeks to discuss the differences among EBP, research and quality improvement. How APNs can incorporate these processes in their roles will also be explored. Steps of research, as well as different EBP models, will also be looked at.

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EBP, Research and Quality Improvement

Research is conducted to either generate new knowledge or validate existing knowledge. Through the use of systematic scientific inquiry, research studies test hypotheses or answer particular research questions. In contrast to research, EBP neither develops new knowledge nor validates existing knowledge. Rather, EBP focusses on the translation of the evidence acquired from scientific research, clinical expertise, as well as patient values and preferences to clinical decision-making. Quality Improvement is meant to use systematic and data-guided approach to enhance processes. The strategies and principles used in quality improvement have evolved from the philosophies of continuous quality improvement and total quality management. Unlike both EBP and research, quality improvement does not involve extensive literature reviews. Moreover, quality improvement projects are site-specific, and the results are neither meant to provide best evidence or generalizable knowledge (Carter, Mastro, Vose, Rivera, and Larson, 2017).

Integration of EBP, Research and Quality Improvement in the Role of APN

APNs are nurses who have specialized in specific fields. The roles depend on the specialization. However, regardless of the role of APN, enhancement of the patient outcomes is critical. Therefore, EBP, research, as well as quality improvement, should be incorporated in their roles. Through research, APNs can acquire new knowledge or validate existing knowledge regarding their roles. For instance, an APN may research ways to prevent catheter-associated urinary tract infections. APNs can also incorporate evidence gained from various studies to improve health outcomes. For instance, following the mentioned research, the evidence gained can be used to prevent catheter-associated urinary tract infections. This would be implementation of EBP. Finally, following the identification of a certain problem, quality improvement can be used to enhance health outcomes (Eccles, Grimshaw, and Foy, 2018). For instance, removing catheters within a specific time frame can help prevent catheter-associated urinary tract infections.

Steps of EBP, Research and Quality Improvement

To ensure the credibility of research results, scientific methods are employed in orderly and sequential steps. First, the researchers identify the questions that need to be answered. A comprehensive review of the existing literature is then carried out in attempts to answer the questions. The knowledge gaps identified provide the basis for the development of research questions and hypotheses (Carter, Mastro, Vose, Rivera, and Larson, 2017). Qualitative or quantitative studies can be used to collect data which then analyzed to answer the specific questions.

Various steps are involved in the EBP process. First, a spirit of inquiry should be cultivated, which then raises various clinical questions. APNs should consistently be asking themselves questions on ways to improve health care delivery. The questions can either be triggered through problem focus or knowledge focus. The most relevant evidence regarding the questions should then be collected and critically appraised. Critical appraisal is carried out to ascertain the credibility of the evidence. This evidence should then be integrated with patient preferences and clinical expertise in making clinical decisions. The practice decision should then be evaluated, and finally, the EBP results should be disseminated.

Quality improvement involves three basic steps. First, the outcomes that need to be improved should be clearly defined. Secondly, the indicators or measures of the outcome should be identified. Finally, a plan for the implementation of the intervention should be developed and the outcomes measured (Flesner et al., 2019).

As mentioned earlier, the credibility of the sources used in research and EBP are of utmost importance. Various databases such as PubMed and Google Scholar, offer access to thousands of peer-reviewed articles on various subjects. Since the immensity of the sources can easily overwhelm a researcher, various filters are provided to help one narrow down to the sources most relevant to their study. For instance, one can choose to search articles in particular journals or within specific timelines.

EBP Models

An EBP model refers to a guideline of steps used by healthcare workers to understand, create, and implement EBP in their roles. Ace Star Model and the John Hopkins Nursing Model are the most popular models. The Ace-Star Model includes five steps; discovery of key research studies, summary and review of the research studies, translation of the findings into clinical practice, integration of the EBP into clinical practice, and evaluation of the effectiveness of the changes (Orta et al., 2016).

The John Hopkins Nursing Model includes three steps; identification of the clinical question, evaluation of the evidence, and translation of the EBP into clinical practice (Dang and Dearholt, 2019). For instance, when using this model to find out whether the occurrence of medical errors rise with increase in the number of working hours, one would search for the most credible studies on the topic and then make recommendations on the number of hours that nurses should work.

Conclusion

Research, EBP, and quality improvement are increasingly being incorporated into the roles of APN. The three processes have been clearly differentiated in this paper. The steps of the processes, as well as their integration into the roles of APNs, have also been examined. The most common models of EBP, the Ace Star Model and the John Hopkins Nursing Model, have also been discussed. Finally, since literature review is important in both research and EBP, a practical exercise has helped understand ways of searching various topics on different databases.

References

Carter, E. J., Mastro, K., Vose, C., Rivera, R., & Larson, E. L. (2017). Clarifying the conundrum: evidence-based practice, quality improvement, or research? The clinical scholarship continuum. Journal of Nursing Administration, 47(5), 266-270. Retrieved from https://journals.lww.com/jonajournal/Fulltext/2017/05000/Clarifying_the_Conundrum___Evidence_Based.6.aspx

Dang, D., & Dearholt, S. (2019). Instructor's Guide for Johns Hopkins Nursing EBP: Model and Guidelines. Sigma Theta Tau International. Retrieved from https://sigma.nursingrepository.org/handle/10755/17100

Eccles, M., Grimshaw, J., & Foy, R. (2018). Disseminating and implementing evidence-based practice. Clinical Governance in Primary Care., 75-88. Retrieved from https://content.taylorfrancis.com/books/e/download?dac=C2015-0-75242-4&isbn=9781315375687&doi=10.1201/9781315375687-7&format=pdf

Flesner, M., Lueckenotte, A., Vogelsmeier, A., Popejoy, L., Minner, D., Galambos, C., & Rantz, M. J. (2019). Advanced Practice Registered Nurses' Quality Improvement Efforts to Reduce Antipsychotic Use in Nursing Homes. Journal of nursing care quality, 34(1), 4-8. Retrieved from https://journals.lww.com/jncqjournal/Fulltext/2019/01000/Advanced_Practice_Registered_Nurses__Quality.2.aspx

Orta, R., Messmer, P. R., Valdes, G. R., Turkel, M., Fields, S. D., & Wei, C. C. (2016). Knowledge and competency of nursing faculty regarding evidence-based practice. The Journal of Continuing Education in Nursing, 47(9), 409-419. Retrieved from https://www.healio.com/nursing/journals/jcen/2016-9-47-9/%7B4f607548-3eed-4228-aa53-4b8e58abb64a%7D/knowledge-and-competency-of-nursing-faculty-regarding-evidence-based-practice