Running Head: EVIDENCE BASED RESEARCH

Evidence Based Research into Clinical Practice

Susan Schultz
James Madison University

EVIDENCE BASED RESEARCH

In the two short months that I have worked Martha Jefferson Hospital (MJH), I
have seen innumerable updates to practice enacted, some seamlessly, and some
with much friction. Epic was a difficult transition, the updates to blood glucose
control was smooth, but our most recent procedure change has nurses in an uproar.
The new protocol allows the emergency department to send a patient to an
inpatient unit without calling report or checking if the new nurse is ready for them.
The transition to this new method is hard for all inpatient nurses to accept due to
increased risks to the patients safety, reflecting that the Sentara corporation is
more concerned with getting patients out of the emergency department and in
profits than insuring the best quality of care. In this instance, nurses could perform
research and present evidence based studies that show the impact to safety, quality
of care, and costs associated with the change. I have volunteered to find articles
associated to this and work with a team on my floor to combat the update. I am also
working on a project regarding decreasing infection rates of ulcers stage 3 or
greater by use of sterile techniques instead of clean when packing the wounds. To
see change, we first have to be willing to make change happen.
At MJH, we have just undergone a significant change in our electronic medical
records system with our transition to Epic. Some staff adapted well while others still
cling to the days of Cerner. The difference between the two groups was flexibility.
Those that transitioned well kept open minds and did not fear change showing ease
of use by the third day. Those who had difficulty transitioning still comment on how
they preferred their old system and even after a month of use have a very difficult
time managing Epic.
Change is an inevitable part of life, how you handle the change is what makes
the experience a positive or negative one. Incorporation of evidence based
competencies into healthcare is likely to lead to a higher quality of care, reliability,
patient outcomes, and reduced costs (Melnyk, GallagherFord, Long, & Fineout

EVIDENCE BASED RESEARCH

Overholt, 2014). I think the best way to combat this is to have staff perform
evidence based research projects every two to five years with a rotation of one or
two staff members presenting every six months. This would allow time for the
changes to be implemented before another is enacted, making change a normal
experience and thus less stressful.
The staff educators at MJH strive to ensure changes to practice are implemented
in the smoothest manner possible. When we changed to Epic, they provided classes,
abilities to explore the applications, ensured we had elbow support staff during the
first two weeks of implementation, and a help line in place for continued support.
They also have started a nurse residency program which consists of an evidence
based practice (EBP) research project that is to be implemented on the floor where
the nurse works. My one gripe with this is that as new graduates we do not have as
much of a rapport with senior staff which can be a challenge during the
implementation phase, that is why I suggested all staff participate in research.
Our staff educators are equivalent to what Blais, Haynes, Kozer, and Erb (2011)
refer to as change agents. Change agents are the backbone and push behind
change, they need to be easily liked and natural leaders. Key characteristics of a
change agent include trustworthiness, confidence, realism articulation, resilience,
integrative thought, flexibility, and sufficiency (Blais, Hayes, Kozier, & Erb, 2011, p.
260). A good change agent should be able to see the big picture while still focusing
on the individual parts required for successful implementation of change. It is very
easy to pick out someone who would be good in this role; they are the person who
steps up and takes charge, volunteers to go first, and has no qualms being different
from everyone else. With this leadership role, they are key in ensuring up-to-date
EBP is used and correctly implemented at the bedside.
To continue to provide our patients with up-to-date EBP care, we as nurses need
to stay educated by reviewing EBP studies or conducting our own. Part of a

EVIDENCE BASED RESEARCH

registered nurse licensure is the ability to apply critical higher level thinking to our
care. Many of us have already enacted personal procedures to improve our patient
care quality, but others simply need a push to take it a step further and make it into
a policy for the unit. If the thought of initiating change scares you, then try to form a
group, so the work is disbursed. As nurses, we are not alone, and all need to play an
active role by advocating for continuous improvements to quality of care.

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5
References

Blais, K., Hayes, J., Kozier, B., & Erb, G. (2011). Professional nursing practice:
concepts and perspectives (6th ed.). Upper Saddle River, NJ: Prentice Hall
Melnyk, B. M., GallagherFord, L., Long, L. E., & FineoutOverholt, E. (2014). The
establishment of evidencebased practice competencies for practicing
registered nurses and advanced practice nurses in realworld clinical settings:
proficiencies to improve healthcare quality, reliability, patient outcomes, and
costs. Worldviews on EvidenceBased Nursing, 11(1), 5-15. DOI:
10.1111/wvn.12021