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List of 24 competencies helps nurses with evidence-based care

Sunday January 26, 2014
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Nurse researchers developed a list of 24 evidence-based practice competencies for RNs and APRNs to use in real-world clinical settings.

The authors recommend that healthcare institutions build these skills into employment expectations, evaluations and clinical ladder promotion systems as part of efforts to implement and sustain evidence-based care.

Numerous studies have suggested that evidence-based care of patients can improve quality of care, reduce medical complications and decrease healthcare costs by as much as 30%. “This is something that we have got to do to improve quality and safety in healthcare and to improve patient outcomes,” Bernadette Melnyk, RN, PhD, CPNP/PMHNP, FNAP, FAAN, the lead author of the published guidelines, dean of The Ohio State University College of Nursing and chief wellness officer for Ohio State, said in a news release.

“We have enough studies to show that evidence-based care can produce these good results as well as fewer complications and hospital readmissions and shorter lengths of stay. But we are talking about behavior change for clinicians, and that’s not a simple process.”

To arrive at the list of competencies, which was published Jan. 21 on the website of the journal Worldviews on Evidence-Based Nursing, the researchers collected expert input from national leaders in evidence-based practice and surveyed 80 nurses who are EBP mentors in healthcare systems across the U.S.

Within the list, 13 items apply to RNs and 11 are intended for APRNs.

The competencies for RNs range from questioning clinical practices for the purpose of improving quality of care, critically appraising published research and collecting and tracking outcomes data that can support the continued use of newly adopted practices. APRNs should be expected to lead teams in applying evidence to initiate practice changes and put strategies into place to sustain a culture that fosters evidence-based practice.

All competencies point toward nurses being actively involved in shifting care from how things always have been done to care that is research-based evidence and deemed most effective.

Full report and list of competencies: http://onlinelibrary.wiley.com/doi/10.1111/wvn.12021/full

The Institute of Medicine has set a goal that 90% of all patient-care decisions be based on evidence by 2020. The Affordable Care Act calls for reimbursable treatments to adhere to evidence-based recommendations made by the U.S. Preventive Services Task Force. Despite these efforts, EBP is far from being universally embraced in many healthcare settings, according to the news release.

In the study, seven national EBP leaders used a consensus-building approach to come up with an initial set of competencies for nurses. These concepts were shared with and refined by the 80 EBP mentors in a multi-round survey until those surveyed reached consensus on a final list.

Melnyk and colleagues recommend that these competencies be incorporated into healthcare system expectations, orientation programs, performance reviews, job descriptions and promotion protocols. Initial presentations about this study have been well-received, she said.

Examples of care not based on evidence abound, noted Melnyk, a former member of the USPSTF. Children having asthma attacks commonly receive a drug to open their airways with a nebulizer in the ED when research has shown that a metered-dose inhaler with a spacer leads to fewer side effects, less ED time and lower chances for hospitalization. Patients with depression typically receive an antidepressant prescription and nothing else despite evidence that cognitive behavior therapy is more effective than medicine for mild to moderate depression.

Melnyk published results from a survey of nurses about evidence-based practice in 2012 that identified barriers to its adoption. Among them was a need for a new direction in nursing education, where many faculty focus their teaching on rigorous research methods and critiques of research rather than how to put research findings to use in clinical practice. The IOM also addressed this issue, advising in a 2003 report that health professional education programs include evidence-based care among five core competencies.

The 2012 survey also suggested that widespread adoption of EBP would require extensive cultural change in healthcare settings. Melnyk has seen the phenomenon firsthand as a longtime consultant with health systems on implementing evidence-based practice.

“Sustainability of evidence-based practice is huge,” she said. “You can have the best knowledge and skills in evidence-based practice, but if you don’t practice in an environment and culture that supports it, chances are it will peter out.

“If healthcare systems adopt these competencies as a gold standard that sets expectations for how nurse professionals function, I think it’s going to catapult the movement for EBP faster than it’s moving right now.”


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