Roy E. Brown, MLIS, AHIP
Research & Education Librarian, Nursing Liaison
Tompkins-McCaw Library for the Health Sciences
Virginia Commonwealth University

Introduction

Healthcare in the United States is increasingly complex, demanding that healthcare providers actively evaluate current care delivery and use evidence to develop new solutions. To operate in this evolving environment, evidence-based practice (EBP) knowledge and engagement are key skills for practitioners. As the library liaison to the nurses of VCU Health, it became clear to me there was variability in nurses’ understanding of the EBP process. This left nurses hesitant to engage in the process and resulted in the uneven quality of EBP project outputs. To address the issue, a team was formed composed of bedside nurses, members of the VCU Health hospital EBP committee, and the nursing library liaison. The project started with the library liaison creating the VCU Inquiry Process Diagram and using it as the framework to create the Evidence-Based Practice Portfolio (EBPP) Tool [1]. The goals of creating the EBPP Tool were to increase the confidence of bedside nurses when undertaking an EBP project, to increase overall nurse engagement with EBP, and to bring uniformity to the EBP activities of nurses at VCU Health.

Methods

The EBPP Tool is an online resource that serves as a roadmap for the EBP process. The tool is built on the LibGuides platform by Springshare. Information is provided through a visual diagram (or flow chart) that incorporates a combination of videos, handouts, references, and a list of appropriate organizational experts to foster networking at each step in the process. The tool provides links to resources for each step in the EBP process along with appropriate forms for documentation. Feedback was solicited from bedside nurses and implemented to ensure the tool was usable and met their needs.

Once the feedback was incorporated into the tool, an implementation plan was developed. This plan was a collaborative effort among the nursing liaison, the chair of VCU Health’s EBP translation committee, and other EBP champions. The plan included training presentations across the organization, the redesign of EBP instructional sessions, identification of a group to pilot the tool, and evaluation of the effort.

At any given time, it is estimated that approximately 100 evidence-based projects are being carried out by nurses at VCU Health. The VCU Health Nurse Residency Program was chosen for the pilot as it is the source of the majority of EBP projects. Nurse residents were provided formal instruction on the fundamentals of EBP and using the tool to ensure a common baseline at the start of the pilot. To ensure that nurse residents had a baseline understanding of EBP and how to use the tool, they received instruction about EBP using the EBPP Tool.

Evaluation

To evaluate the effectiveness of the educational effort and the EBPP Tool, those who used the tool were surveyed using the Upton and Upton EBP Questionnaire. The EBP Questionnaire is a validated tool composed of 24 questions using a five-point Likert scale to measure the knowledge, practice, and attitudes of nurses toward evidence-based practice [2]. If the implementation of the tool was effective, it was believed there would be positive increases in nurses’ self-reports to the questions across all domains of the questionnaire. Each participant in the 2016-2017 nurse residency cohort was emailed a link to the questionnaire at the beginning and end of the program.

Results

Comparison of the before and after questionnaire responses revealed a general improvement across all three domains with the largest difference observed in the responses to the question that gauged whether respondents felt EBP was worth engaging in within the clinical environment. In items related to participant knowledge and associated skills of EBP, there were modest increases. The positive trend in survey findings was further reflected in items related to EBP utilization, with improvements in responses to every question.

Conclusions

Based on the questionnaire responses and anecdotal evidence, the project has been a success. It continues to be supported by VCU Health and is used to carry out evidence-based practice projects. This project is a good example of the value health science librarians can bring to healthcare organizations through the improved use of EBP. Health science librarians can support EBP by partnering with nurses, physicians, and other healthcare practitioners to play a key role in improving skills related to obtaining, evaluating, and synthesizing evidence aimed at improving use of evidence and, subsequently, patient care.

References

1. Brown, R. E. (2018). VCU Health Nursing Inquiry Process Diagram (version 2). https://scholarscompass.vcu.edu/libraries_pubs/52/

1. Upton, D., & Upton, P. (2006). Development of an evidence-based practice questionnaire for nurses. Journal of Advanced Nursing, 53(4), 454–458. https://doi.org/10.1111/j.1365-2648.2006.03739.x