In bed with evidence: a hospital's experience

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Nurses’ use of the best available evidence at the point of care relies on a trifecta of practical underpinnings. First, evidence must be readily accessible to nurses and in an easy to read format (i.e. mechanical/functional).1 Second, the suite of nursing practice procedures, policies and competencies must be relevant and kept updated with the best available evidence (i.e. quality). Third, nurses in their daily practice must be willing and have the curiosity and courage to raise questions concerning their practice and the evidence base (i.e. culture2,3). For a thriving and sustainable interrelationship, these three underpinnings must be continually evaluated and nurtured. Common sense it seems, but the orchestration is rather complex and the structures, processes and outcomes that Avedis Donabedian proposed in 1966 still serve us well today when examining the infrastructure needed in order to achieve embedded evidence in a hospital setting.4 The aim of this editorial is to highlight the infrastructure that supports evidence-based practice (EBP) at University of California, San Francisco Medical Center (UCSF).
Donabedian defined structure as the resources and organization of the settings in which care occurs. The UCSF Centre for Evidence Synthesis and Implementation: a Joanna Briggs Center of Excellence is based in a hospital setting, therefore, patient and family care are naturally at the forefront of our question identification in terms of evidence synthesis and implementation work. Our quaternary 1000-bed academic medical center relies on a centralized team of clinical nurse educators, clinical nurse specialists, clinical nurse informaticists, evidence implementation specialists, clinical nurse researchers, and clinical research librarians to support, coach and train 4000 nurses. This centralized group is also known as team members of the Institute for Nursing Excellence (INEx), which is where the UCSF Centre for Evidence Synthesis and Implementation is housed. The three arms of INEx – Education and Training, Clinical Inquiry, and Practice – are the heart of evidence-based, excellent nursing care (see Figure 1). While the patient and family are at the center of our work, the members of INEx work through the nurses and other frontline staff to ensure clinicians are supported to provide consistently reliable and excellent, evidence-based care.
Maintaining our Magnet® designation keeps us focused on transformational leadership, structural empowerment, exemplary professional practice, and new knowledge and innovations. One of the cornerstones to Magnet is shared decision-making. Providing collaborative venues to discuss, evaluate and analyze evidence and our practice engages direct-care nurses and supports innovation and sustained change. Our shared decision-making core councils and other key practice committees comprise mostly direct-care nurses. The Clinical Practice Council evaluates needed practice revisions and makes recommendations for change based on the extant evidence. The Clinical InQuERI5 Council uses a variety of approaches to support all forms of clinical inquiry, including quality improvement initiatives, evidence-based practice at the point of care, primary and secondary research projects, and innovation. The Professional Development Council is charged with ensuring that nurses have access to educational and professional development opportunities, including pursuing specialty certification. These shared decision-making councils are key to any change that impacts nursing care, documentation, and/or practice and each council requires strong evidence to move projects forward. Through these structures, use of evidence to effect change at the point of care has become ingrained.
Nurses at the UCSF Medical Center are uniquely situated to create, synthesize, transfer, implement and evaluate evidence with one clear goal in mind: excellent patient and family outcomes. This shared goal is due, in part, to the processes that we have in place – or what is actually done – to support our patient and family outcomes.
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