Evidence-Based Professional Nursing Practice

Chapter 10 Evidence-Based Professional Nursing Practice Evidence-Based Practice: What Is It? • Evidence-based practice (EBP) is a framework used by nurses and other healthcare professionals to deliver optimal health care through the integration of best current evidence, clinical expertise, and patient/family values Why Is EBP Relevant in Nursing? (1 of 2) • Helps resolve problems in the clinical setting • Results in effective patient care and better outcomes • Contributes to the science of nursing through the introduction of innovation to practice • Keeps practice current and relevant by helping nurses deliver care based upon current best research Why Is EBP Relevant in Nursing? (2 of 2)

• Decreases variations in nursing care and increases confidence in decision making • Supports Joint Commission on Accreditation of Healthcare Organizations (JCAHO)readiness since policies and procedures are current and include the latest research • Supports high quality patient care and achievement of Magnet status Steps in the EBP Process (1 of 2) • Cultivate a spirit of inquiry and culture of EBP among nurses and within the organization • Identify an issue and ask the question • Search for and collect the most relevant and best evidence to answer the clinical question Steps in the EBP Process (2 of 2) • Critically appraise the evidence and synthesize the evidence • Integrate evidence with clinical expertise and patient preferences to make the best clinical decision • Evaluate the outcome of any EBP change • Disseminate the outcomes of the change Barriers to EBP in Nursing (1 of 3) • Lack of value for research in practice • Difficulty in changing practice

• Lack of administrative support • Lack of knowledgeable mentors • Insufficient time • Lack of education about the research process • Lack of awareness about research or EBP Barriers to EBP in Nursing (2 of 3) • Research reports/articles not readily available • Difficulty accessing research reports and articles • No time on the job to read research • Complexity of research reports • Lack of knowledge about EBP • Lack of knowledge about the critique of articles Barriers to EBP in Nursing (3 of 3) • Feeling overwhelmed by the process • Lack of sense of control over practice • Lack of confidence to implement change • Lack of leadership, motivation, vision, strategy, or direction among managers Promoting EBP: Individual Nurse

• Educate yourself about EBP • Conduct face-to-face or online journal clubs, share new research reports and guidelines with peers, and provide support to other nurses • Share your results through posters, newsletters, unit meetings, or a published article • Adopt a reflective and inquiring approach to practice Strategies to Promote EBP: Organizations • Specific identification of the facilitators and barriers to EBP • Education and training to improve knowledge and strengthen beliefs related to the benefits of EBP • Creation of an environment that encourages an inquisitive approach to patient care PICO(T) • P: Patient, population, or problem • I: Intervention, exposure, or topic of interest • C: Comparison or alternate intervention • O: Outcome • (T): Time or timeframe PICO(T) Questions • In (patient or population), what is the effect of (intervention or exposure) on (outcome) compared with (comparison or alternate intervention)? • For (patient or population), does the introduction of (intervention or exposure) reduce the risk of (outcome) compared with (comparison or alternate intervention)? Electronic Resources

• National Library of Medicine • Cochrane Library • National Guideline Clearinghouse • Joanna Briggs Institute • Agency for Healthcare Research and Quality • Centre for Health Evidence • Registered Nurses’ Association of Ontario Evaluation of Evidence • What is the source of the information? • When was it developed? • How was it developed? • Does it fit the current clinical environment? • Does it fit the current situation? Levels of Evidence • Meta-analysis or systematic reviews of multiple welldesigned controlled studies • Well-designed randomized controlled trials • Well-designed nonrandomized controlled trials • Observational studies with controls • Systematic review of descriptive and qualitative studies • Single descriptive or qualitative study • Opinions of authorities and/or reports of expert committees Appraisal of Research Using the Critical Appraisal Skills Programme (CASP) • Checklists provide tools to interpret research evidence • Checklists are specific to types of research • Checklists provide frameworks to determine strength and reliability of research reports Institute of Medicine (IOM) Standards for Clinical Practice Guideline Development • STANDARD 1: Establishing • STANDARD 2: Management of conflict of interest • STANDARD 3: Guideline development group composition • STANDARD 4: Use of systematic reviews • STANDARD 5: Establishing evidence and strength of recommendations • STANDARD 6: Articulation of recommendations • STANDARD 7: External review • STANDARD 8: Updating Appraisal of Guidelines for Research and Evaluation (AGREE II) • Scope and purpose • Stakeholder involvement • Rigor of development • Clarity and presentation • Application • Editorial independence AGREE II Category #1

• Scope and purpose – Overall objectives of the guideline are specifically described – The health questions covered by the guideline are specifically described – The population to whom the guideline is meant to apply are specifically described AGREE II Category #2 • Stakeholder involvement – Guideline development group includes individuals from all relevant professions – The views and preferences of the target population have been sought – Target users of the guideline are clearly defined AGREE II Category #3 (1 of 2) • Rigor of development – Systematic methods were used to search for evidence – The criteria for selecting the evidence are clearly described – The strengths and limitations of the body of evidence are clearly described – The methods used for formulating the recommendations are clearly described AGREE II Category #3 (2 of 2) • Rigor of development (cont.) – The health benefits, side effects, and risks have been considered in formulating recommendations – There is an explicit link between the recommendations and the supporting evidence – The guideline has been externally reviewed by experts prior to publication – A procedure for updating the guideline is provided AGREE II Category #4

• Clarity and presentation – Recommendations are specific and unambiguous – Different options for management of the condition or health issue are clearly presented – Key recommendations are easily identifiable AGREE II Category #5 • Application – The guideline describes facilitators and barriers to its application – The guideline provides advice and/or tools on how the recommendations can be put into practice – The potential resource implications of applying the recommendations have been considered – Guideline presents monitoring and/or auditing criteria AGREE II Category #6 • Editorial independence – The views of the funding body have not influenced the content of the guideline – Competing interests of guideline development group members have been recorded and addressed Implementation Models for EBP • Center for Advancing Clinical Evidence (ACE) Star Model of Knowledge Transformation • The Iowa Model of Evidence-Based Practice • Agency for Healthcare Research and Quality Model • Johns Hopkins Nursing Evidence-Based Practice Model

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Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice, and government regulations often change the accepted standard in this field. When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product. This is especially important in the case of drugs that are new or seldom used. 08323-1 Production Credits VP, Executive Publisher: David D. Cella Executive Editor: Amanda Martin Acquisitions Editor: Teresa Reilly Editorial Assistant: Danielle Bessette Production Editor: Vanessa Richards Senior Marketing Manager: Jennifer Scherzay VP, Manufacturing and Inventory Control: Therese Connell Composition: Integra Software Services Pvt. Ltd. Cover Design: Kristin E. Parker Rights & Media Specialist: Wes DeShano Media Development Editor: Shannon Sheehan Cover Image: © robertiez/iStock/Getty Images Plus/Getty Printing and Binding: RR Donnelley Cover Printing: RR Donnelley Library of Congress Cataloging-in-Publication Data Role development in professional nursing practice / [edited by] Kathleen Masters. – Fourth edition. p. ; cm. Includes bibliographical references and index. ISBN 978-1-284-07832-9 (pbk.) I. Masters, Kathleen, editor. [DNLM: 1. Nursing–standards. 2. Nursing–trends. 3. Nurse’s Role. 4. Philosophy, Nursing. 5. Professional Practice. WY 16] RT82 610.73–dc23 2015022040 6048 Printed in the United States of America 19 18 17 16 15 10 9 8 7 6 5 4 3 2 1 Dedication This book is dedicated to my Heavenly Father and to my loving family: my husband, Eddie, and my two daughters, Rebecca and Rachel. Words cannot express my appreciation for their ongoing encouragement and support throughout my career. Contents Preface Contributors xv xix UNIT I: FOUNDATIONS OF PROFESSIONAL NURSING PRACTICE 1 1 3 2 A History of Health Care and Nursing Karen Saucier Lundy and Kathleen Masters Classical Era Middle Ages The Renaissance The Dark Period of Nursing The Industrial Revolution And Then There Was Nightingale… Continued Development of Professional Nursing in the United Kingdom The Development of Professional Nursing in Canada The Development of Professional Nursing in Australia Early Nursing Education and Organization in the United States The Evolution of Nursing in the United States: The First Century of Professional Nursing The New Century International Council of Nurses Conclusion Evidence-Based Professional Nursing Practice

References 3 6 8 9 10 13 22 23 25 27 28 39 40 41 43 Frameworks for Professional Nursing Practice 49 Kathleen Masters Overview of Selected Nursing Theories Nurse of the Future: Nursing Core Competencies Overview of Selected Non-Nursing Theories Relationship of Theory to Professional Nursing Practice Conclusion References 51 84 87 88 89 92 X 3 4 5 6 CONTENTS Philosophy of Nursing 99 Mary W. Stewart Philosophy Early Philosophy Paradigms Beliefs Values Developing a Personal Philosophy of Nursing Conclusion References 100 101 103 104 106 110 112 114 Foundations of Ethical Nursing Practice 117 Janie B. Butts and Karen L. Rich Ethics Ethical Theories and Approaches Professional Ethics and Codes Ethical Analysis and Decision Making in Nursing Conclusion References 118 121 126 129 134 135 Social Context of Professional Nursing 137 Mary W. Stewart, Katherine Elizabeth Nugent, Rowena W. Elliott, and Kathleen Masters Nursing’s Social Contract with Society Public Image of Nursing The Gender Gap Changing Demographics and Cultural Competence Access to Health Care Societal Trends Trends in Nursing Conclusion References 138 139 143 146 148 151 156 166 166 Evidence-Based Professional Nursing Practice

Education and Socialization to the Professional Nursing Role 173 Kathleen Masters and Melanie Gilmore Professional Nursing Roles and Values The Socialization (or Formation) Process Facilitating the Transition to Professional Practice Conclusion References 174 176 180 181 183 CONTENTS 7 Advancing and Managing Your Professional Nursing Career UNIT II: PROFESSIONAL NURSING PRACTICE AND THE MANAGEMENT OF PATIENT CARE Patient Safety and Professional Nursing Practice 185 187 190 193 194 197 198 199 201 202 205 207 Jill Rushing and Kathleen Masters Patient Safety Critical Thinking, Clinical Judgment, and Clinical Reasoning in Nursing Practice Conclusion References 9 185 Mary Louise Coyne and Cynthia Chatham Nursing: A Job or a Career? Trends That Impact Nursing Career Decisions Showcasing Your Professional Self Mentoring Education and Lifelong Learning Professional Engagement Expectations for Your Performance Taking Care of Self Conclusion References 8 XI Quality Improvement and Professional Nursing Practice 207 216 231 233 237 Kathleen Masters Healthcare Quality Measurement of Quality The Role of the Nurse in Quality Improvement Conclusion References 237 240 249 251 253 Professional Nursing Practice 10 Evidence-Based Kathleen Masters 255 Evidence-Based Practice: What Is It? Barriers to Evidence-Based Practice Promoting Evidence-Based Practice Searching for Evidence Evaluating the Evidence Implementation Models for Evidence-Based Practice Conclusion References 255 257 258 259 262 265 268 270 XII 11 CONTENTS Patient-Centered Care and Professional Nursing Practice 273 Kathleen Masters Dimensions of Patient-Centered Care Communication as a Strategy to Support Patient-Centered Care Patient Education as a Strategy to Support Patient-Centered Care Evaluation of Patient-Centered Care Conclusion References in Professional Nursing Practice 12 Informatics Kathleen Masters and Cathy K. Hughes Informatics: What Is It?

The Impact of Legislation on Health Informatics Nursing Informatics Competencies Basic Computer Competencies Information Literacy Information Management Current and Future Trends Conclusion References and Collaboration in Professional Nursing Practice 13 Teamwork Sharon Vincent and Kathleen Masters Healthcare Delivery System Nursing Models of Patient Care Roles of the Professional Nurse Interprofessional Teams and Healthcare Quality and Safety Interprofessional Collaborative Practice Domains Interprofessional Team Performance and Communication Conclusion References Issues in Professional Nursing Practice 14 Ethical Janie B. Butts and Karen L. Rich Relationships in Professional Practice Moral Rights and Autonomy Social Justice Death and End-of-Life Care Conclusion References 274 276 278 293 294 295 301 301 302 304 307 311 314 319 320 321 325 326 328 332 335 338 339 343 344 347 348 353 355 360 370 371 CONTENTS and the Professional Nurse 15 Law Kathleen Driscoll, Kathleen Masters, and Evadna Lyons XIII 375 The Sources of Law Classification and Enforcement of the Law Nursing Scope and Standards Malpractice and Negligence Nursing Licensure Professional Accountability Conclusion References 376 378 381 384 387 392 400 402 Appendix A Standards of Professional Nursing Practice Appendix B Provisions of Code of Ethics for Nurses Appendix C The ICN Code of Ethics for Nurses Glossary Index 405 407 409 411 429 PrefaCe Although the process of professional development is a lifelong journey, it is a journey that begins in earnest during the time of initial academic preparation. The goal of this book is to provide nursing students with a road map to help guide them along their journey as a professional nurse. This book is organized into two units. The chapters in the first unit focus on the foundational concepts that are essential to the development of the individual professional nurse. The chapters in Unit II address issues related to professional nursing practice and the management of patient care, specifically in the context of quality and safety.Evidence-Based Professional Nursing Practice

In the fourth edition, the chapter content is conceptualized, when applicable, around nursing competencies, professional standards, and recommendations from national groups, such as Institute of Medicine reports. The chapters included in Unit I provide the student nurse with a basic foundation in areas such as nursing history, theory, philosophy, ethics, socialization into the nursing role, and the social context of nursing. All chapters have been updated, and several chapters in Unit I have been expanded in this edition. Revisions to the chapter on nursing history include the addition of contributions of prominent nurses and achievements related to nursing in the United Kingdom, Canada, and Australia. The theory chapter now includes additional nursing theorists as well as a brief overview of several non-nursing theories frequently used in nursing research and practice. The social context of nursing chapter now incorporates not only societal trends, but also trends in nursing practice and education. The chapter related to professional career development in nursing has been completely rewritten for this edition. The chapters in Unit II are more directly related to patient care management. In the fourth edition, Unit II chapter topics are presented in the context of quality and safety. Chapter topics include the role of the nurse in pat …Evidence-Based Professional Nursing Practice