Title: Understanding and Articulating the Differences Between QI, Research or Evidence Based Practice
1Understanding and Articulating the Differences
Between QI, Research or Evidence Based Practice
- Regina Taylor, MN, RN, ACNS-BC
2Objectives
- 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
3A precursor to leading is understanding the
distinct differences, yet overlapping
associations between those 3 important
activities. (Newhouse, p.435)
4Quality 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
5Examples 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
6Nursing Research
- A systematic search for knowledge about issues
of importance to the nursing profession. (Polit
and Hungler, 1995)
7Example 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
8QI or Research
- Form hypothesis
- Study protocol/Data collection
- Analysis and interpretation of data
- Implementation into practice
- (Kring, p. 163)
9QI or Research?
- Intervention
- Risk
- Audience
- Data source
- (Reinhardt and Ray, p.5)
10Differences
- Philosophical underpinning
- Purposes
- EBP value
- Generalizability
- Beneficiaries
- Risks and Burdens
- Sample Size
- Instruments
- Design and methods
- Implementation of findings
- Social acceptance
(Kring, 2008)
11Evidence-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.
12Examples 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
13Integration of QI, EBP, and NR
QI
Met
Not Met
EBP
Evidence
No Evidence
NURSING RESEARCH
14If in doubt.
- Ask the experts
- Nurse researchers/scientists
- Quality Management
- Institutional Review Board
- Advance Practice Nurses
- Affiliated faculty
15Strategies 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)
16Additional 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
17Preparing the workforce involves developing
competencies in QI, EBP, informatics,
patient-centered care, and interdisciplinary
collaboration.(Newhouse, p. 435)
18Magnet 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
19Evidence 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.
20Research 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
21Research SOE (cont.)
- The institutions 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)
22Research 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.
23References
- 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.
24Questions? Contact Regina Taylor, MN, RN,
ACNS-BC Regina.taylor_at_va.gov 404-321-6111. ext.
6487