Simulating an Evidence-based Practice Committee to Teach Pre-licensure Students the Evidence-based Practice Process

Submitter Information

Author: Elizabeth Murray, PhD, RN, CNE
Title: Associate Professor
Institution: Florida Gulf Coast University School of Nursing
Email: emurray@fgcu.edu

Competency Category(s)
Evidence-Based Practice, Teamwork and Collaboration

Learner Level(s)
Pre-Licensure BSN

Learner Setting(s)
Classroom

Strategy Type
General Strategy

Learning Objectives

This teaching strategy addresses the following KSAs related to Evidence-based Practice and Teamwork and Collaboration QSEN Core Competencies:

Evidence-based Practice
The learner will:
• Differentiate clinical opinion from research and evidence summaries.
• Describe reliable sources for locating evidence reports and clinical practice guidelines.
• Explain the role of evidence in determining best clinical practice.
• Describe how the strength and relevance of available evidence influence the choice of interventions
in the provision of patient-centered care.
• Read original research and evidence reports related to area of practice.
• Locate evidence reports related to clinical practice topics and guidelines.
• Value the concept of EBP as integral to determining best clinical practice.

Teamwork and Collaboration
The learner will:
• Describe your own strengths, limitations, and values in functioning as a member of a team.
• Acknowledge your own potential to contribute to effective team functioning.
• Describe impact of own communication style on others
• Value teamwork and the relationships upon which it is based

Strategy Overview

Purpose
The purpose of this group activity is to build on previous learning related to evidence-based practice that occurred during the term. Learners function as members of an Evidence-based Practice Committee at Eagles Community Hospital (named for the University mascot) and engage in the evidence-based practice process.

Overview
This activity uses the Johns Hopkins Nursing Evidence-based Practice (JHNEB) Model and learners are required to use the book, The Johns Hopkins Nursing Evidence-based Practice: Model and Guidelines (3rd ed.) by Dang and Dearholt. Prior to participating in this group activity, learners engaged in the following individual activities:
1. Learners explored and defined a clinical problem, described significance to nursing, and developed a PICOT question.
2. Next, learners identified keywords and established a search strategy to explore the evidence related to their PICOT question.
3. Learners conducted a literature search related to their PICOT question and selected three (3) pieces of evidence to appraise using the JHNEB Appraisal Tool for Research (Appendix E) and JHNEB Appraisal Tool for Non-Research (Appendix F). Leaners were required to select at least one (1) evidence summary and one (1) piece of primary evidence.
4. Finally, leaners created a summary matrix of the above evidence appraisals using the JHNEB Evidence Summary Tool (Appendix G).

Learners will function as an Evidence-based Practice Committee (EBP) for Eagles Community Hospital. Learners are divided into groups based on the condition/topic selected at the beginning of the semester. Committee members identify a clinical practice (nursing intervention) that is well-supported by evidence and related to the symptom selected by the team. Members will conduct the synthesis process to identify a recommendation to address a PICOT question. The EBP committee will develop a PowerPoint presentation to promote adoption of the clinical practice by nursing staff (classmates). This activity is divided into three (3) parts.

Part 1:
Learners form an EBP Committee of 3-4 members who are interested in the same clinical problem.
1. The committee members will select a Committee Facilitator who will be responsible for keeping the team on task, assigning deadlines for members to submit additional materials, facilitate discussions, and report committee activities in class using report sheet by uploading to team files in the learning management system (LMS) or Google Docs.
2. Members will share their Individual Evidence-based Summaries with each other and discuss the following related to each member’s Evidence-based Summaries (discussion can take place face-to-face or in an online forum):
a. What symptoms were addressed?
b. What nursing interventions were identified?
c. Was there significant evidence?
d. What were the levels of evidence identified using JHNEB Evidence Level and Quality Guide (Appendix
D)? Were all levels of evidence identified? If not, what was missing?
e. Were there Clinical Practice Guidelines (CPGs) related to the interventions identified?
3. Members identify the levels of evidence missing and conduct a review for each. Then each member will bring evidence (1 piece) from each missing level back to the committee for review.
4. The Committee will summarize work using the EBP Committee Report sheet and the facilitator will present to the class the following week.

Part 2:
1. The EBP Committee will review all members’ Evidence-based Summaries and select one (1) symptom and one (1) nursing intervention to address that symptom. The nursing intervention MUST be an autonomous intervention nurses can perform without requiring collaboration with a primary care provider (MD, OD, ANP, PA).
2. The Committee will write a PICOT question using the symptom and nursing intervention selected.
3. Next, the Committee will review all members’ Evidence-based Summaries and choose evidence specifically related to the symptom and nursing intervention selected and summarize the evidence using the Evidence Summary Matrix (combine previous evidence).
a. Evidence Summary Matrix MUST include:
i. Eight (8) pieces of evidence
ii. A minimum of one (1) piece of evidence for each level
b. Learners may need to conduct searches for additional evidence.
4. The Committee will engage in the Synthesis Process using the JHNEB Synthesis Process and Recommendations Form for the eight (8) pieces of evidence. The members will refer to Appendix H in textbook for Key Points for this discussion.
5. Once completed, the Committee Facilitator will present to class.

Part 3:
The Committee will review Synthesis of Findings and:
1. Finalize recommendation for clinical practice change
2. Determine which Translation Pathway represents the overall strength of the evidence (the overall strength should qualify for the Strong Pathway or the Good Pathway).
3. Discuss the fit and feasibility of the clinical practice change.
4. Finally, the EBP Committee will outline the results of the EBP Process and their Action Plan for Success using the Action Plan Planning Tool (Appendix I) in a PowerPoint presentation and present it to the class.

Submitted Materials

316.-Simulating-EBP-Committee-Strategy-Overview.docx
316.-Self-Assessment-Peer-Assessment.docx
316.-Rubric-for-EBP-Committee-Presentation.docx
316.-EBP-Committee-Report-Sheet.docx

Additional Materials

For detailed student guidelines for each part of the teaching strategy and the presentation, please contact emurray@fgcu.edu

The Johns Hopkins Nursing Evidence-based Practice Model and tools are available here: https://www.hopkinsmedicine.org/evidence-based-practice/ijhn_2017_ebp.html

Evaluation Description

1. Upon completion of the presentations, learners conduct a self-assessment of their contributions and collaboration as a team member and peer-assessment using a rating scale of 0-5 (0=minimum effort and 5= outstanding effort) of several KSAs related to the Teamwork and Collaboration Core Competency.
2. Learners are graded individually for their work on Parts 1, 2, & 3 (see rubrics attached).
3. Learners are graded on their PowerPoint and on their individual presentations (see rubric attached).

Learners
Although response rates on the Perception of Instruction Surveys at the end of the term were low (8 out of 30 responding), they were positive. On the item “Overall this course was effective in improving my knowledge of course content” 87.5% indicated strongly agree and 12.5% indicated agree.
Learner Comments
“The PowerPoint and doing each step of the process each week helped me fully grasp what all goes into EBP committees”.

“The course group project was very helpful in supporting learning…provided a more in-depth look at the material and the group project allowed me to work on my communication and teamwork skills”.

“I think this class really helped me better understand the process behind EBP and when to apply it in patient settings”.

“The class gave a lot of insight into evidence-based care, the importance and how we can research and implement it in the future”.

Faculty
Rubrics are used to evaluate Parts 1, 2, & 3 of the strategy as well as the group presentations Faculty believe that student feedback and evaluations demonstrated learners gained knowledge of evidence-based practice and teamwork and collaboration. In addition, learners valued the group experience.

This strategy can be used in a face-to-face course or online course.