Advancing Evidence-Based Practice through Association Initiatives

1. Knowledge Utilization Initiatives from Associations: AWHONN’s CVH for Women and NAPNAP’s HEAT Initiatives Knowledge Utilization/Transfer: From Theory to Practice KU-03 Colloquium, Quebec September 25-26, 2003 Karen KellyThomas, PhD, RNC, FAAN Executive Director, NAPNAP Cherry Hill, NJ

2. Objectives • Describe an association based theory, program model and strategy that promotes and advances evidence-based clinical practice • Describe ways to achieve desired organizational and health outcomes in communities served by association members • Compare commonalities and differences in application of KU/translation theory and models among associations and other groups

3. Disclosure • Karen Kelly Thomas was an employee of AWHONN during the time this model and program were developed. She is now employed by NAPNAP. • AWHONN applies for and receives federal grants and government service contracts. • In addition, AWHONN seeks and receives unrestricted grants and contributions from multiple sources, including but not limited to Johnson & Johnson, Procter & Gamble, and Pfizer. • As Executive Director of NAPNAP, Karen Kelly Thomas seeks and receives unrestricted grants and contributions from multiple sources, including those listed above and others.

4. Be not afraid of going slowly, be only afraid of standing still. Chinese Proverb Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.Samuel Beckett

5. AWHONN RBP Program Purpose • Advance evidence-based clinical practice in women’s health, obstetric and neonatal nursing • Measure clinical efficacy and effect on health outcomes of project guideline • Meet standard bearer and guideline development responsibility • Transfer specific research-based knowledge and innovation into practice to improve clinical practice of nurses and other health care providers for the care of women and newborns and to evaluate the effectiveness of that transfer of knowledge (Gennaro, 1994) Making the unknown known is the important thing – and keeping the unknown always beyond you. Georgia O’Keeffe

6. Assumptions • Fit with AWHONN mission, strategy, focus areas and goals • Available body of validated knowledge ready for transfer into practice • Memberscommitted to improve practice to ensure high quality nursing care

7. Theoretical Influences • Change • Behavioral (Prochaska & DeClemente) • Organizational (Deming) • Research Utilization • Clinical nursing (Stetler, Horsley, Haller) • Clinical practice (Oxman) • Knowledge and innovation diffusion (Rogers) • Adult learning (Knowles) • Other • Interpretative research (Denzin, Diekelman, Benner) • Project management/logistics (Block) • Translation research • Synchronicity (Jung)

8. Jung’s Synchronicity • An acausal connecting principle • As ‘meaningful coincidences’ • Not dismissing irrational data, rather attempting to integrate them by whatever means are at hand • Interpretation for KU? Jung, 1969

9. AWHONN Emerging Model Clinical Site and Circumstances Clinical Expertise Patient Preferences and Actions Research Evidence Clinical Context Health Care Practice Environment Adapted from Haynes et al (2002)

10. P r o c e s s F l o w C h a r t Phase I Planning Phase III: Evaluation/Decision Making Phase II Implementation Phase IV: Dissemination Identifies clinical topic RC Appoints science team (RC/AS) • Training site coordinators (ST) • Collecting baseline data (SC) • Implementing project guideline (SC) • Collecting data after guideline implementation (SC) • Analyze final data and recommendations (ST) • Redefining guideline (ST) • Writing outcome report (STL) Topic to guideline teams Defining focus & scope Securing Funds Refining scope of science and writing clinical question for project (ST) • EBP Guideline Flowchart • Dissemination • Use Reviewing & scoring science base (ST) no STOP Guidance for Practice Validated yes Writing evidence-base considered for project guideline (STL) Key AS – AWHONN Staff AP – Advisory Panels RC – Research Committee ST – Science Team STL – Science Team Leader Developing project guideline (ST) Presenting evidence-base For project guideline (ST) Selecting sites

11. Outcomes • Measurable progress toward AWHONN strategic plan and goals • Measures of project effect on health and lives of women and newborns • Disseminate and diffuse association experience’s effect on clinical practice

12. AWHONN Evidence-Based Clinical Practice Guideline (EBG) Development Program • Inception in 1998 as a result of collaborative effort of AWHONN Practice, Research and Education Committees • AWHONN framework for guideline development based on American Nurses Association Manual to Develop Guidelines (Marek, 1995) • AWHONN Evidence-Based Clinical Practice Guidelines have been accepted for inclusion in Agency for Healthcare Research and Quality (AHRQ) National Guideline Clearinghouse

13. Why Evidence-Based Clinical Practice Guidelines? • Promotes nursing profession’s commitment to practice based on best available evidence • Provides clinical practice recommendations and rationale based on current evidence “at-a-glance” • Enhances credibility with evidence-based “talking points” to facilitate collaboration with other health care providers about pertinent patient care issues • Provides stimulus for further reading and research • Provides basis for continuing education programs • Provides basis for CQI projects and outcomes evaluation

14. AWHONN’s Cardiovascular Health for Women Initiative • Third stage, DHHS contracts to specific regions • Trained several tiers and types of nurses to implement specific strategy • Implemented in practice setting community and consumer groups • CQI effort continues with recruitment and 4 follow-ups assessments regarding smoking cessation, nutrition, activity, and stress management

15. Great works are performed, not by strength, but by perseverance.Samuel Johnson

16. Products • Articles in refereed journals • Presentations at conventions and meetings • Presentation packages • Clinical practice monographs with CE • Online CE learning • Workshops • ACG specific products

17. NAPNAP’s Healthy Eating and Activity Together (HEAT) Initiative • Reduce prevalence of overweight and obese children by 5% (1994 baseline=11% of 6-19 year olds are overweight or obese) • Multi-year, multiple components addressing advocacy, education, research and practice improvement • Organizing resources and tools on web and print • Testing ‘do-ability’ factors and effect on BMI • Led by a Steering Work Group with 7 core work groups • Strategic and tactical alliances being made during next three months; funding sought; EB committed

18. Opportunities and Threats • Opportunities • Walking among giants • Members are best of the best • Commitment to test “do-ability factor” • Welcoming creativity • Threats • HIPPA fears of unknown • IRBs and human subjects protection • Data sharing • Funding We are each born so creative – then we forget our purpose, our mission. We believe our doubts and fears, and slowly stop ‘being creative’ as though it was a separate thing. Sark

19. Riding the dragon Every problem has two handles. You can grab it by the handle of fear or the handle of hope. Margaret Mitchell

20. Key Facilitators • Volunteer members • Association commitment • Project support staff/liaison • Site organization support • Human subject protection templates • Money • Creativity

21. A Path to Seeking and Achieving Desired Outcomes Competence development Research utilization Clinical practice outcomes Health outcomes in community Patient information and education

22. Creating Real Roles Champion and leader Truth seeker and teacher Logician and magician

23. Be not afraid of going slowly, be only afraid of standing still. Chinese Proverb Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.Samuel Beckett