Strategies to Promote & Integrate Clinical Inquiry

1. Strategies to Promote & Integrate Clinical Inquiry Heather Craven, PhD, RN, CMSRN Nurse Scientist, MUSC Health

2. Objectives: Upon completion of this session participants are able to: • Define the concept and scope of Clinical Inquiry in nursing and healthcare. • Describe the fundamental components of an environment of clinical inquiry. • Identify strategies they can use to promote and integrate clinical inquiry in their work environment.

3. Framework for Clinical Inquiry

4. Clinical Inquiry leads to • Better patient outcomes • Increased satisfaction • Reduced costs • Nurses feel empowered • Increased engagement • Increased retention and recruitment • Reduced costs

5. Institute of Medicine Goal: By the year 2020, 90 % of clinical decisions will be: • supported by accurate, timely, and up-to-date clinical information • will reflect the best available evidence.

6. Clinical Inquiry Integrated into ANCC Credentialing Programs Pathway to Excellence Magnet Designation Research Clinical nurses are involved in nursing research and disseminate findings. Evidence-based practice Nurses evaluate and use evidence-based findings in their practice Innovations Nurses involved in design and implementation of new technology, work flow improvements & space design • Quality program & Evidence-based practice • Policies are evidence based • New knowledge and evidence used to improve nursing practice • Nurses actively participate in outcome-based quality initiatives

7. Where are we at?

8. Barriers to Clinical Inquiry • Lack of knowledge/skills • Lack of organizational support • Translating findings to real world practice • Fear of criticism for challenging status quo • Lack of time & energy • Lack of resources

9. Types of Strategies ?

10. Organizational Readiness Is Clinical Inquiry part of the… Are there structures and processes… Shared governance Access to evidence Mentors/coaches Education • Vision/Mission/Values • Strategic Plan • Organizational Goals • Job descriptions • Performance evaluation

11. Building Infrastructure • Vision/Mission/Values • Strategic Plan/Goals • Experts/Mentors • Database

12. Select a Model

13. Generating Questions • Brainstorming • Focus Groups • Surveys • Contests

14. Skill Building: Journal Clubs

15. Skill Building: EBP Rounds • Experienced nurse researches clinical question • Presents findings during regularly scheduled meetings • Based on evidence, group develops • Implementation strategies • Expected outcomes • Plans shared through unit using “Practice Alerts” or fact sheets • Feedback is encouraged

16. Skill Building: Fellowship/Scholar Programs • Educational Component • Mentor/Preceptor • Resources • Accountability

17. Skill Building: EBP/Research Councils • Possible activities: • Practice writing questions • Conduct evidence reviews • Collaborate on reviewing research and appraising • Review research proposals going to IRB • Conduct a research study • Participate in a multi-site study (Stanley, Sitterding, Broome, & McCaskey, 2011)

18. Staff Engagement • See “Generating Questions” • Clinical Inquiry topics in newsletters • Awards/recognitions • Celebrations

19. Questions/Comments cravenh@musc.edu

20. References • Albert, N. (Ed.) (2016). Building and sustaining a hospital-based nursing research program. New York: Springer Publishing Company. • Bethel, S., Seitz, S., Landreth, C., Gibson, L., and Whitcomb, J. (2012). Energize staff to create a research agenda. Clinical Nurse Specialist, 26(5), 272-276. • Brockopp, D., Schreiber, J., Hill, K., Altpeter, T., Moe, K., and Merritt, S. (2011). A successful evidence-based practice model in an acute care setting. Oncology Nursing Forum, 38(5), 509-511. • Latimer, R. and Kimbell, J. (2010). Nursing research fellowship: Building nursing research infrastructure in a hospital. The Journal of Nursing Administration, 40(2), 92-98. • Melnyk, B., Gallagher-Ford, L, and Fineout-Overholt, E. (2017). Implementing the evidence-based practice competencies in healthcare: A practical guide for improving quality, safety, & outcomes. Indianapolic, IN: Sigma Theta Tau International. • Melnyk, B.M., Fineout-Overholt, E., Gallagher-Ford, L., and Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. The Journal of Nursing Administration, 42(9), 410-417.

21. References • Newhouse, R., Pugh, L., Dearholt, S., White, K., and Poe, S. (2007). Organizational change strategies for evidence-based practice. The Journal of Nursing Administration, 37(12), 552-557. • O’Byrne, L. and Smith, S. (2010). Models to enhance research capacity and capability in clinical nurses: A narrative review. Journal of Clinical Nursing, 20, 1365-1371. • Schulman, C. (2007). Clinical Inquiry. In M.A. McKinley (Ed.), Acute and Critical Care Clinical Nurse Specialists: Synergy for Best Practices (77-89). St. Louis, Missouri: Saunders. • Stanley, T., Sitterding, M., Broome, M. , and McCaskey, M. (2011). Engaging and developing research leaders in practice: Creating a foundation for a culture of clinical inquiry. Journal of Pediatric Nursing, 26, 480-488. • Weitzel, M. and Robinson, S. (2011). Nursing research week: Promoting staff nurse awareness of research activities through a week long celebration. Journal of Nurses in Staff Development, 27(6), 280-284.

22. Websites • http://guides.mclibrary.duke.edu/ebm • http://www.ahrq.gov/cpi/centers/cepi/index.html • http://www.hopkinsmedicine.org/evidence-based-practice • https://ctep-ebp.com/ • https://uihc.org/iowa-model-revised-evidence-based-practice-promote-excellence-health-care • https://www.clinicalkey.com/nursing