Education Plan Promotes Use of Evidence-Based Practice

LAS VEGAS—A multiphase education plan can promote the use of evidence-based practice among oncology nursing staff, according to a report presented at the 32nd Annual Congress of the Oncology Nursing Society (abstract 1856).

"Among all healthcare disciplines, the value of basing healthcare practice on high-quality evidence is unchallenged, and at the Congress here we have heard again and again the importance of using evidence-based practice to encourage patient safety and patient outcomes," said lead author Cynthia J. Briola, RN, OCN, of the Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia.

Her institution's magnet status, she added, is another impetus to ensuring that all providers are delivering care based on the best available evidence. "We know that we do an excellent job in evidence-based practice," she said. "However, we want to really be sure we are doing a good job with all of the nurses being able to use evidence-based practice at the bedside."

In 2005, the Evidence-Based Practice Council at the center formulated an education plan to promote use of this practice by nurses, Ms. Briola said. The plan's goals were to support a culture shift from traditional toward evidence-based practice, to educate nurses about the principles of this type of practice, to increase their comfort in accessing evidence-based practice resources, and to promote incorporation of evidence into their clinical practice.

Four Phases

The plan had four phases and certain built-in requirements, she said: "It was to be mandatory for all RNs. It was to accommodate all shifts. It needed to be easily accessible. And we needed to figure out how to educate future nursing staff."

In phase I of the plan, started in January 2006, a nurse educator gave an overview of evidence-based practice principles, Ms. Briola said. The nurse educator described evidence-based practice, explained why it was important to integrate it into care, offered examples of questions to study, identified relevant resources at the center, showed how to search the available information, and defined the levels of evidence and gave examples.

In phase II, members of the center's Evidence-Based Practice Council guided small groups of nurses through six poster presentations of evidence-based projects. They used a question-and-answer format to stimulate discussion on topics such as the resources used; the level of evidence reviewed; the literature search strategies used; the type of evidence (qualitative vs quantitative) evaluated; and the presence of so-called PICOT elements (P, patient population of interest; I, intervention of interest; C, comparison of interest; O, outcome of interest; and T, time frame).

In phase III, center librarians introduced nurses to evidence-based practice resources and taught them principles of conducting literature searches, largely through use of a roving library cart.

"A librarian would go to each unit every other Tuesday and Thursday, and on that cart she had a laptop with a wireless Internet connection, and books and journals," Ms. Briola explained. "The nurses could ask her to help them do a literature search, and she would do the search right then and there." The librarian also oriented nurses to the center's medical library and internal web portal for conducting searches.

In phase IV, each nursing unit undertook a mandatory evidence-based practice project that culminated in a poster presentation. "Not all nurses needed to participate in this project, but they were encouraged to participate, no matter how great or small their role," Ms. Briola said. "It could be as simple as reading a research article. It could be putting the poster together or just picking up the poster boards from the nursing office."

Examples of project topics included the management of skin reactions during radiation therapy, use of diversion to improve wait time in the infusion room, relationship-based care, patient education about oral chemotherapy, and use of Ritalin (methylphenidate) at the end of life to ease symptoms such as fatigue.

Posters Evaluated

The posters were presented at the Nurse's Week celebration dinner; evaluated according to the question studied, the level of evidence used, and the integration of the findings into clinical practice; and ranked according to which posters nurses thought their colleagues would most like to see. "The top eight posters will be presented at our nursing grand rounds," Ms. Briola noted.

Education plan materials are accessible to all nursing staff at any time by videotape and through an education-on- demand page on an internal website, Ms. Briola said. On the web page, for example, nurses can view the overview of evidence-based practice from phase I; a virtual poster session, listing the posters along with the questions developed for them, from phase II; and a presentation on evidence-based library resources, along with a quiz, from phase III.

"We are in the process of developing a survey to evaluate all four phases of our evidence-based practice education plan," Ms. Briola said, which will ask nurses about their experience. In addition, she and her colleagues will assess the impact of the plan on nursing practice and patient outcomes, and have decided to make the evidence-based practice unit project an annual event. "The journey in culture shift is a process—it does not happen overnight. We recognize that there will be challenges and perhaps barriers, but you can and you should integrate evidence into practice," she concluded.