Envisioning EBP Implementation

EBP Nursing Promoting EBP The goal of evidence-based practice (EBP) implementation, according to Purdy and Melwak (2009), is to exploit research findings so ". that every patient receives the right care every time" (p. 263). The recommended steps for EBP implementation are (1) develop a well-framed question, (2) find the best evidence, (3) critically evaluate scientific findings, (4) implement, and (5) evaluate efficacy. Step 3 seems to be a critical step, because the quality of research findings may not be sufficient to justify EBP implementation.

In other words, there should be another step between 3 and 4 where the doctor of nursing practice (DNP)-prepared nurse decides whether the quality of the evidence is sufficient to justify implementation. These steps, however, help to define the role a DNP-prepared nurse can play in EBP implementation. Yoder and colleagues (2014) distinguish between research utilization and EBP by limiting the former to the implementation of scientific findings; whereas, EBP takes advantage of scientific findings in addition to expert opinions, clinical expertise, and patient feedback.

This comparison suggests the role of DNP-prepared nurses in EBP implementation is more than digesting empirical research findings, evaluating evidence quality, and applying the findings to practice, but includes a holistic approach that evaluates evidence from multiples sources. The type of change induced by EBP was also broken down by Yoder and colleagues (2014) into instrumental, conceptual, and symbolic utilization, which are defined as changes in nursing practice, cognitive process, and policymaker attitudes. This further defines the role and scope of DNP-prepared nurses in EBP implementation.

Within a multidisciplinary team, the responsibility for EBP and research utilization tends to fall on nurse leaders, managers, and educators (Yoder et al., 2014, p. 36). Based on the findings of Yoder and colleagues (2014), unit nurses tend to rely on nursing leadership and DNP-prepared nurses to be active consumers of research, even if they have been trained in EBP. Accordingly, nursing leaders, especially clinical nurse specialists (CNS) when available, will often represent the driving force behind EBP.

Yoder and colleagues (2014) also note that senior nurses may not have had formal EBP training, but that their clinical expertise will be critical to the success of a multidisciplinary EBP team; therefore, senior nurses should be encouraged to take EBP classes offered by the hospital or through a nearby academic institution. Yoder and colleagues (2014) provided some sense of what is possible in a well-functioning multidisciplinary team, when the CNS carries the burden of being head researcher (p. 33).

One survey respondent participated in a team consisting of physicians, respiratory, nurse practitioners, and others, but the CNS was instrumental in accessing, evaluating, and making EBP recommendations to the team. The CNS also provided information and access to ongoing, multisite, national studies. It is not hard to imagine that this team, consisting of diverse professions and expertise, could make significant instrumental, conceptual, and symbolic EBP contributions. Decades of empirical research.