Translating Evidence Into Practice Susan E. Shapiro, PhD, RN - - PowerPoint PPT Presentation

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Translating Evidence Into Practice Susan E. Shapiro, PhD, RN - - PowerPoint PPT Presentation

Feb 20, 2024 100 likes •277 views

Translating Evidence Into Practice Susan E. Shapiro, PhD, RN Associate Chief Nursing Officer, Emory susan.shapiro@ emoryhealthcare.org Healthcare Assistant Dean for Strategic Clinical Initiatives, Nell Hodgson Woodruff School of Nursing

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susan.shapiro@ emoryhealthcare.org

Translating Evidence Into Practice

Susan E. Shapiro, PhD, RN

Associate Chief Nursing Officer, Emory Healthcare Assistant Dean for Strategic Clinical Initiatives, Nell Hodgson Woodruff School of Nursing

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Objectives

  • Identify six important steps in planning for

change

  • Identify important components to

implementing an EBP change

  • Differentiate between process and outcome

evaluation

  • Describe importance of both process and
  • utcome evaluations in assessing effectiveness
  • f change
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Source

Shapiro, SE & Donaldson, NA. (2008) Evidence-based practice for advanced practice emergency nurses, part III: Planning, implementing, and evaluating an evidence-based small test of

  • change. Advanced Emergency

Nursing Journal .30 (3) 222-232

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Review of EBP Process

  • Common elements

– Problem identified – Search for evidence – Appraise and synthesize evidence – Identify best practice and perform gap analysis – Plan, implement, and evaluate best practice – Adopt, adapt, or abandon – Scale up

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Planning the change

  • Change process more complex

than it seems

  • Gap analysis should have

identified the what: policies, procedures, practices

  • Key stakeholders (the who):

everyone affected by the change

  • Microsystem analysis very helpful

(www.clinicalmicrosystem.org)

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Planning for Change

  • Ensure support from leadership
  • Assemble your team

– Identify champions to assist with the change

  • Facilitate two way communications
  • Reinforce training wherever change is

happening

  • Remind stakeholders of the reasons for

the change and desired outcomes

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Planning the Change

  • Develop the timeline

– What happens when – By whom – Work backwards from implementation date and adjust accordingly

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Planning the Change

  • Communication plan

– What needs to be communicated? – To whom does it need to go? – What is the best way to get it there? (eight different times; eight different ways) – Keep it brief; “brand” the change – Timing – not too near; not too far

  • Use anticipatory techniques, e.g. “stay

tuned…”

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Training Plan

  • Different stakeholders need

different training tailored to the changes they will experience

  • Training large numbers of

stakeholders a challenge

– Timing the training related to the change – Releasing staff/paying for training

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Implementing the Change

  • 2-step process: implementing the

change and sustaining the change

  • Implementation

– Set the date – be strategic (e.g. Tuesday) – Be present for the change – Acknowledge and reward the pioneers, e.g. provide refreshments – Don’t expect perfection

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Implementing the Change

  • Sustaining the change

– Often the harder of the 2 steps

  • Old habits die hard
  • Remove old forms, supplies,

equipment

  • Enlist change champions to help

monitor level of adherence over minimum of 2 weeks, 24/7

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Evaluating the Change

  • Evaluation plan should have been

part of initial project

  • Focus on both process and
  • utcome evaluations
  • Use existing data sources to the

extent possible

– Avoid unvalidated surveys of staff or patients

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Evaluating the Change

  • Timing of the evaluation is critical

– Short term evaluation within three months – Longer term evaluation after 6 months

  • Evaluations will determine next

step in the process, i.e. to adopt, modify, or abandon the change

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Random Thoughts

  • Change is hard
  • Gradual, incremental change is

easier than sudden, radical change

  • The more time invested in each

step of the process the greater the probability of successfully changing practice and improving

  • utcomes
  • If it didn’t work, figure out why

and fix it.

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Successful Implementation

SI=f(E x C x F)

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Exemplar Case

  • Emory Healthcare Nursing

Bedside Shift Report