Understanding and Articulating the Differences Between QI, Research or Evidence Based Practice

1. Understanding and Articulating the Differences Between QI, Research or Evidence Based Practice Regina Taylor, MN, RN, ACNS-BC

2. Objectives • Differentiate between quality improvement, research and evidence based practice in nursing • Discuss strategies to ensure nurses at all levels in all areas of practice understand and can describe the differences

3. “A precursor to leading is understanding the distinct differences, yet overlapping associations between those 3 important activities.”(Newhouse, p.435)

4. Quality Improvement • “Systematic, data-guided activities designed to bring about immediate improvement in healthcare delivery in particular settings.” (Lynn, et al, 2007, p. 667*) *= From ANCC Magnet Application Manual, 2008

5. Examples of QI • Nursing Sensitive indicators • Performance Measures • Compliance checks • Example: Examination of use of intervention at unit/facility level to attempt to decrease patient falls

6. Nursing Research • “A systematic search for knowledge about issues of importance to the nursing profession.” (Polit and Hungler, 1995*)

7. Example of Nursing Research • Testing of an innovation that may impact nursing practice in general (i.e. including outside of the facility), such as to prevent falls or injury from falls or pressure ulcers

8. QI or Research QI Rapid Cycle Process Research Process Form hypothesis Study protocol/Data collection Analysis and interpretation of data Implementation into practice (Kring, p. 163) • Plan • Do • Study • Act

9. QI or Research? • Intervention • Risk • Audience • Data source (Reinhardt and Ray, p.5)

10. Differences • Philosophical underpinning • Purposes • EBP value • Generalizability • Beneficiaries • Risks and Burdens • Sample Size • Instruments • Design and methods • Implementation of findings • Social acceptance (Kring, 2008)

11. Evidence-Based Practice • “Conscious use/integration of the best research evidence with clinical expertise and patient preferences in nursing practice (adapted from Sackett, et al, 2000*) • EBP is a science-to-service model of engagement of critical thinking to apply research-based evidence (scientific knowledge) and practice-based evidence (art of nursing) within the context of patient values to deliver quality, cost-sensitive care.

12. Examples of EBP • Use of evidence-based standards from professional organization • Use of research to guide protocols • Institute for Healthcare Improvement (IHI) bundles • Specifics: • Safe patient handling • Falls prevention • Pressure ulcer prevention • Restraint free environments

13. Integration of QI, EBP, and NR QI Met Not Met EBP Evidence No Evidence NURSING RESEARCH

14. If in doubt…. • Ask the experts • Nurse researchers/scientists • Quality Management • Institutional Review Board • Advance Practice Nurses • Affiliated faculty

15. Strategies to ensure differentiation • Educational seminars, including • Grand Rounds (evidence based case study analyses) • Webinars • Reinforcement/Education at the bedside • Documentation: • EBP Fact Sheets • Website • Use of tools (Rating, differentiation, such as Kring, p. 167) • Journal Clubs (in person, on line)

16. Additional Strategies • Establish reasonable budget (as separate FCP or line items) for research • Start with basic education for staff: Research process, protection of human subjects, sharing your findings; enhance all staff nurses ability to evaluate research using their selected tool • Assist staff with verbalizing how research is systematically reviewed and used for evidence based practice; focus on enculturation of research and EBP • Articulate, and develop further, relationship with academic affiliates and own research staff, including MDs, regarding staff developing research skills/mentoring • Facilitate attendance at research and EBP conferences. • Assist with local research and EBP conferences

17. “Preparing the workforce involves developing competencies in QI, EBP, informatics, patient-centered care, and interdisciplinary collaboration.”(Newhouse, p. 435)

18. Magnet Requirements: Educational • List continuing education programs (classroom or electronic) and the number of nurses completing each during the past 24 months. Do not include orientation or inservice education. Include programs covering… • Research, including protection of human subjects • Evidence-based practice • Application of ethical principles • Quality improvement • Data and information analysis competencies

19. Evidence Based Practice SOE • Describe and demonstrate • The structure(s) and process(es) used to evaluate existing nursing practice, based on evidence • The structure(s) and process(es) used to translate new knowledge into nursing practice. • How translation of new knowledge into nursing practice has affected patient outcomes.

20. Research SOE • Provide annual report (research efforts and presentations could be included here) • Provide a budget summary for most recent fiscal year, actual to budget, for nursing education, conference attendance, and research

21. Research SOE (cont.) • The institution’s policies, procedures (including IRB) and processes that protect the rights of participants in research (NK 2) • The credentials or related experience of all external experts and other resources used to develop and/or improve the infrastructures, capacities, and processes for evidence-based practice and research (NK4 and NK 4EO)

22. Research SOE (Cont.) • Describe and demonstrate • Consistent membership and involvement by at least one (1) nurse in the governing body responsible for the protection of human subjects in research, and that a nurse votes on nursing-related protocols. • The structure(s) and process(es) used by the organization to develop, expand, and/or advance nursing research. • Nursing research studies from the past 2 years, ongoing or completed, generated from the structure(s) and process(es) above. Provide a table including: • Study title • Study status • Principal investigator name(s) • Principal investigator credential(s) • Role(s) of nurses in the study • Study scope (internal to a single organization, multiple organizations within a system independent organizations collaboratively) • Study type (replication-yes or no; qualitative, quantitative, or both). Select one (1) completed research study and respond to the four (4) criteria listed in the guidelines provided.

23. References • ANCC Manual, 2008 • Newhouse, R. (October, 2007). “Diffusing Confusion between Evidence Based Practice, Quality Improvement and Research.” Journal of Nursing Administration. Vol 37. No. 10, 432-435. • Kring, D. (June, 2008). “Research and Quality Improvement: Different Processes, Different Evidence.” MED/SURG Nursing. Vol. 17, No. 3, 162-169. • Reinhardt, A, and Ray, L. (February, 2003). “Differentiating Quality Improvement from Research.” Applied Nursing Research. Vol 16, No. 1, 2-8.

24. Questions? Contact: Regina Taylor, MN, RN, ACNS-BC Regina.taylor@va.gov 404-321-6111. ext. 6487