Translating Evidence into Practice - The Johns Hopkins Nursing Experience by M. DeGrazia, K. White

Summary

Dr. Kathleen White, Director of the MSN Entry into Nursing Program at Johns Hopkins, discusses the development of an evidence-based practice model at Hopkins Hospital, focusing on practical applications for bedside nurses. She shares insights on how the Johns Hopkins Nursing Evidence-based Practice Model was created, tested, and refined to improve patient outcomes. The discussion highlights key components such as the PET process (Practice Question, Evidence Search & Evaluation, and Translation) and the importance of interdisciplinary collaboration. Dr. White also shares successful examples of evidence-based practice projects, demonstrating the model's impact on healthcare practices.

Takeaways

• 😀 Dr. Michele DeGrazia introduces Dr. Kathleen White, a prominent figure in evidence-based practice and nursing leadership at Johns Hopkins School of Nursing.
• 😀 Dr. White's interest in evidence-based practice began in 1999, driven by the need to improve patient outcomes and quality of care in nursing.
• 😀 Johns Hopkins developed its own evidence-based practice model after reviewing existing ones, focusing on practical implementation for bedside nurses.
• 😀 The Johns Hopkins Nursing Evidence-based Practice Model emphasizes the importance of research and guidelines, incorporating 18 now 19 key guidelines for nurses to follow.
• 😀 The PET process (Practice question, Evidence search & evaluation, Translation) is central to their model, helping nurses implement evidence-based changes effectively.
• 😀 The model encourages collaboration across disciplines, including physicians, pharmacists, and other stakeholders to improve patient care.
• 😀 Dr. White’s team tested their model in real-world settings through five pilot projects, refining their approach based on outcomes and feedback.
• 😀 A successful project at Johns Hopkins involved revising the practice of requiring PACU patients to void before discharge, leading to more personalized care and improved patient satisfaction.
• 😀 The evidence-based practice model has led to measurable improvements in patient outcomes, including the development of national guidelines for specific practices.
• 😀 Johns Hopkins provides a platform for sharing EBP projects through its website, allowing for scaling and replication of successful interventions across departments and institutions.
• 😀 A multidisciplinary approach is essential in defining and answering practice questions, as shown in a project to standardize the frenotomy procedure for newborns with tongue tie, involving collaboration between nurses and physicians.

Q & A

What inspired Dr. Kathleen White to focus on evidence-based practice?

Dr. White was inspired by her work at Johns Hopkins Hospital starting in 1999, where she joined an outcomes management committee and began questioning whether existing protocols and policies were achieving the desired outcomes. This led her to explore evidence-based practices in nursing and medicine.

How did Dr. White and her team develop the Johns Hopkins Nursing Evidence-Based Practice Model?

Dr. White and her team set out to adopt an existing model for evidence-based practice, but after reviewing several options, they decided to develop their own. They created a model based on their goals for improving practice at the bedside and developed 19 guidelines to support nurses in identifying practice questions, evaluating evidence, and implementing changes.

What role does evidence-based practice play in improving outcomes in healthcare?

Evidence-based practice helps ensure that clinical decisions are based on the best available evidence, leading to improved patient outcomes. By integrating research findings into everyday practice, healthcare professionals can optimize care and enhance both patient satisfaction and safety.

What is the PET process in the evidence-based practice model?

The PET process stands for Practice question, Evidence search and evaluation, and Translation. It is a simple three-phase process that helps nurses identify practice questions, search for relevant evidence, critique and synthesize the findings, and then translate the evidence into practice.

Why is it important to involve a multidisciplinary team in evidence-based practice projects?

Involving a multidisciplinary team ensures that all relevant stakeholders are considered, from nurses to physicians and other specialists. This collaboration helps ensure the practice question is well-defined and that the evidence is applied appropriately across different healthcare areas, improving the overall effectiveness of practice changes.

Can you provide an example of a successful evidence-based practice project at Johns Hopkins?

One successful project involved re-evaluating the practice of requiring PACU patients to void before discharge. The evidence suggested that not all patients needed to void, and after piloting this change, the hospital saw positive outcomes, including improved patient satisfaction and shorter PACU stays.

What guidelines and forms were developed to support the evidence-based practice process?

The team developed about 19 guidelines and numerous forms to assist nurses in evaluating research evidence. These forms help nurses consider important factors such as sample size, research design, bias, and the quality of the evidence to ensure that practice changes are based on solid research.

How does the Johns Hopkins model support bedside nurses in implementing evidence-based practices?

The model is designed to be user-friendly, providing clear steps and guidelines for bedside nurses to follow. This helps them translate evidence into practice without being overwhelmed by complexity. The model emphasizes education and training to equip nurses with the skills needed to evaluate and apply evidence effectively.

What role does communication play in the evidence-based practice process at Johns Hopkins?

Communication is vital in ensuring that all stakeholders are informed and involved. This includes frequent updates, discussions with physicians, and feedback from nurses and other team members. Effective communication ensures that everyone understands the evidence and supports the implementation of practice changes.

How does Johns Hopkins ensure that evidence-based practices are sustainable over time?

Johns Hopkins maintains a dedicated website to document evidence-based practice projects, which includes summaries and links to further information. This allows nurses to revisit previous projects, ensuring that practice changes are continuously updated in line with new research and evidence.