A critical component of any change project is an evaluation of the stakeholders and determination of an effective communication plan to support successful implementation of the evidence-supported chan

A critical component of any change project is an evaluation of the stakeholders and determination of an effective communication plan to support successful implementation of the evidence-supported chan
Johns Hopkins Evidence-Based Practice Model for Nursing and Healthcare Professionals Stakeholder Analysis and Communication Tool Appendix C Stakeholder Analysis Identify the key stakeholders: ☐ Manager or direct supervisor ☐ Finance department ☐ Vendors ☐ Patients and/or families; patient and family advisory committee ☐ Professional organizations ☐ Committees ☐ Organizational leaders ☐ Interdisciplinary colleagues (e.g., physicians, nutritionists, respiratory therapists, or OT/PT) ☐ Administrators ☐ Other units or departments ☐ Others: ________________ Stakeholder analysis matrix: (Adapted from http://www.tools4dev.org/) Stakeholder Name and Title: Role: (select all that apply) Responsibility, Approval, Consult, Inform Impact Level: How much does the project impact them? (minor, moderate, significant) Influence Level: How much influence do they have over the project?   (minor, moderate, significant) What matters most to the stakeholder? How could the stakeholder contribute to the project? How could the stakeholder impede the project? Strategy(s) for engaging the stakeholder: Communication Planning Refer to this section to guide your communications to stakeholders throughout and after completing the EBP project. What is the purpose of the dissemination of the EBP project findings? (check all that apply) ☐ Raise awareness   ☐ Promote action   ☐ Change policy  ☐ Change practice  ☐ Engage stakeholders  ☐ Inform stakeholders  ☐ Other:________________  What are the 3 most important messages?        Align key message(s) and methods with audience: Audience  Key Messages  Method  Timing  Interdisciplinary stakeholders       Organizational leadership       Frontline nurses       Departmental leadership       External community       Other       Directions for Use of the Stakeholder Analysis and Communication Tool See Chapter 11, Lessons from Practice, for examples of completed tools. Purpose: The EBP team uses this form to identify key stakeholders. Key stakeholders are persons, groups, or departments that have an interest in, concern about, or stake in your project. This may include approval, subject matter expertise, or resources. Communicate with stakeholders early in the process and keep them updated on progress to ensure their buy-in for implementation. Because stakeholders may change at different steps of the process, we recommend that you review this form as you proceed from step to step in your action plan. The communication planning section is useful to promote communication throughout the EBP project process. Ideally, complete the communication section toward the end of the EBP project when the team has identified organization-specific recommendations. Identify the key stakeholders (broad categories): Consider the various areas, departments, groups, or organizations that may be impacted by or have influence over the proposed practice change. Stakeholder analysis matrix: Using the prompts from above, identify the five to seven stakeholders who can most affect (or who will be most affected by) the results and who can influence the success of the translation work. Consider which of the four roles each stakeholder may play in your action planning and translation work. The possible roles are: Responsibility – Completes identified tasks. Recommending authority Approval – Signs off on recommendations. May veto Consult – Provides input (e.g., subject matter experts). No decision-making authority Inform – Notified of progress and changes. No input on decisions Remember that one stakeholder may fill different roles, depending on the action. Completion of the Stakeholder Analysis Tool will help clarify roles and responsibilities. The descriptions of responsibilities for each role provided on the form will be helpful in this process. EBP teams should consider the amount of impact the project may have on the stakeholder and the amount of influence the stakeholder can have on the project’s success. Identifying the ways the stakeholder can both contribute to and impede the project’s success as well as how best to engage the stakeholder allows teams to develop plans to optimize the best outcomes. Align key message(s) and methods with audience: Audience: Think about the project recommendations. Identify the end users—who is your audience?  Revisit the Stakeholder Analysis Tool above to confirm stakeholders and key messages they need to receive. What do you want the target audience(s) to hear, know, and understand?    Key Messages: Messages should be clear, succinct, personalized to the audience, benefit-focused, actionable, and repeated 3-6 different times and ways. Method: Communication can occur on many levels using varying strategies.   Internal dissemination methods can include newsletters, internal website, private social media groups, journal clubs, grand rounds, staff meetings, tool kits, podcasts, and lunch-and-learns.  External dissemination can be in the form of conference poster and podium presentations, peer-reviewed articles, opinion pieces, letters to the editor, book chapters, interviews, or social media (blogs, Twitter, YouTube).  Timing: When will your message have the most impact? Consider the audience and time communication when the content may be most relevant to them and their priorities. Also, keep in mind events such as holidays and the academic calendar which can distract audiences’ attention.  © 2022 The Johns Hopkins Hospital/Johns Hopkins University School of Nursing Page | 5
A critical component of any change project is an evaluation of the stakeholders and determination of an effective communication plan to support successful implementation of the evidence-supported chan
To meet the needs of the modern healthcare system, the Institute of Medicine (IOM), now the National Academy of Medicine, published a set of five core competencies required of each health professional. This is not an exhaustive list but represents those competencies com – mon among a variety of health professionals and those most impor – tant to advancing healthcare. These competencies included providing patient-centered care, working in interdisciplinary teams, applying quality improvement, utilizing informatics, and employing evidence- based practice (IOM, 2003). As a core competency, evidence-based practice (EBP) represents a significant skill for nurses and other healthcare providers who have considerable influence on healthcare decisions and improving the quality and safety of care. EBP allows clinicians and interprofessional teams to keep up with the rapidly changing environment. The world is experiencing an information and technology explo – sion, and healthcare is no exception. Unfortunately, in healthcare, the growth of knowledge outpaces the application to practice. The 1 Evidence-Based Practice: Context, Concerns, and Challenges Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 4 process of incorporating new knowledge into clinical practice is often c onsider – ably delayed. Curry (2018) reports that it may take up to 15 years to approve new drugs. The average time for the uptake of research into actual pract ice is 17 years (Hanney et al., 2015). New knowledge has grown exponentially. Early in the 20th century, many healthcare professionals had but a few, hard-to-access journals available to them. Today, MEDLINE indexes 5,600 journals (National Library of Medicine, 2020), with more than 26 million references. The Cumulative I ndex to Nursing and Allied Health Literature (CINAHL) indexes more than 5,500 jour – nals and includes more than 3.4 million records (EBSCO Publishing, 2020 ). Ac – cessibility of information on the web also has increased consumer expect ation of participating in treatment decisions. Patients with chronic health probl ems have accumulated considerable expertise in self-management, increasing the pr essure for providers to be up to date with the best evidence for care. Despite this knowledge explosion, healthcare clinicians can experience a decline in knowledge of best care practices that relates to the amount of informati on avail – able and the limited time to digest it when no longer in a school or tra ining envi – ronment. Estabrooks (1998) reported that knowledge of best care practi ces nega – tively correlated with year of graduation—that is, knowledge of best care practices declined as the number of years since graduation increased. EBP is one o f the best strategies to enable healthcare providers to stay abreast of new practic es and tech – nology amid this continuing information explosion. The objectives for this chapter are to: ■ Define EBP ■ Describe the evolution of EBP in healthcare ■ Discuss EBP in relation to outcomes and accountability ■ Highlight the healthcare clinician’s role in EBP Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 5 EBP: Definition EBP is a problem-solving approach to clinical decision-making within a h ealthcare organization. EBP integrates the best available scientific evidence wi th the best available experiential (patient and practitioner) evidence. EBP uses a deliberate approach to consider internal and external influences on practice and to encourage critical thinking in the judicious application of such evidence to the c are of individual patients, a patient population, or a system (Dang & Dearholt , 2018). The challenge for healthcare providers is to use such evidence to implem ent the best interventions to improve patient outcomes. The Johns Hopkins Evidence-Based Practice Model (JHEBP) for Nursing and Healthcare Profe ssionals provides a structured and systematic way for clinicians to effectively u se current research and nonresearch evidence to determine best practices an d provide safe, high-quality care. EBP supports and informs clinical, administrative, and educational decis ion- making. Combining research, organizational experience (including qualit y improvement and financial data), clinical expertise, expert opinion, and patient preferences ensures clinical decisions based on all available evidence. EBP enhances efficacy (the ability to reach a desired result); efficie ncy (the achievement of a desired result with minimum expense, time, and effort); and effect iveness (the ability to produce a desired result). Additionally, EBP weighs risk, benefit, and cost against a backdrop of patient preferences. This evidence-based decision- making encourages healthcare providers to question practice and determin e which interventions are ready to be implemented in clinical practice. EBP can lead to: ■ Optimal outcomes ■ Reductions in unnecessary variations in care ■ Standardization of care ■ Equivalent care at lower cost or in less time ■ Improved patient satisfaction ■ Increased clinician satisfaction and autonomy ■ Higher health-related quality of life Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 1 Evidence-Based Practice: Context, Concerns, and Challenges 6 The History EBP in healthcare is not conceptually new. From a nursing perspective, Florence Nightingale pioneered the concept of using research evidence to dictate care (Nightingale, 1858). In the 1920s, Mary McMillan worked to bring a sci entific basis to the practice of physical therapy and to standardize the practic e (American Physical Therapy Association, 2020). As with any applied sci ence, the terms associated with evidence-based practice changed as the science evo lved. As early as 1972, Archibald L. Cochrane, a British medical researcher, criticized the health profession for administering treatments not supported by evid ence (Cochrane, 1972). By the 1980s, the term evidence-based medicine was b eing used at McMaster University Medical School in Canada. Positive reception given to systematic reviews of care during pregnancy and childbirth prom pted the British National Health Service in 1992 to approve funding for “a Cochrane Centre” to facilitate the preparation of systematic reviews of random ized controlled trials of healthcare, eventually leading to the establishment of the Cochrane Collaboration in 1993 (Cochrane Collaboration, 2016). Cochran e continues to provide systematic reviews about the effectiveness of healt hcare and sound scientific evidence for providing effective treatment regimes. I n 1996, Alan Pearson founded the Joanna Briggs Research Institute (now JBI) to link research with practice, thus impacting global health outcomes and providing evide nce to inform clinical decision-making (JBI, 2020). The use of tradition and ritual was and still is the basis for care by m any clini – cians. To use research in clinical practice, many disciplines sought scientifi c back – ing for common practices. For example, the Conduct and Utilization of Re search in Nursing Project (CURN) (Horsley et al., 1978) aimed to develop an d test a model for bringing research knowledge into clinical practice. Through th e initial work, ten areas were identified as having adequate evidence to use in practice, and the authors published guidelines and nursing protocols for each area (Hors – ley et al., 1983): ■ Structured preoperative teaching ■ Reduction of diarrhea in tube-fed patients Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 7 ■ Preoperative sensory preparation to promote recovery ■ Prevention of decubitus ulcers ■ Intravenous cannula change ■ Closed urinary drainage systems ■ Distress reduction through sensory preparation ■ Mutual goal-setting in patient care ■ Clean intermittent catheterization ■ Deliberate nursing interventions to reduce pain This is just one example of many to highlight the beginning of using res earch in practice. However, EBP incorporates more than research findings. Clinician experience, patient preference, and internal organizational data are all used as evidence to inform decisions and improve patient outcomes. Building on t hese early efforts, EBP has evolved to include increasingly sophisticated ana lytical techniques; improved presentation and dissemination of information; adva nced tools for searching and tracking literature; growing knowledge of how to implement findings while effectively considering patient preferences, costs, and policy issues; and a better understanding of how to measure effect and u se feedback to promote ongoing improvement. The Push for EBP EBP has experienced tremendous growth in the past few decades. For examp le, the first detailed description of EBP and nursing in primary care was published in 1996; less than 10 years later, an entire journal dedicated to EBP, Worldviews on Evidence-Based Nursing, was published. This growth can be attributed to two main factors. First, as mentioned previously, knowledge development is outpacing our ability to put findings into practice, driving the ne ed for a systematic way of evaluating evidence. Second, the development of EBP ha s been further driven by a desire to improve outcomes, pressure from consumers for more accountability, and regulatory requirements by accreditation bodies. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 1 Evidence-Based Practice: Context, Concerns, and Challenges 8 EBP and Outcomes Healthcare providers, by nature, have always been interested in the outc omes and results of patient care. Traditionally, such results have been characterized in terms of morbidity and mortality. Recently, however, the focus has broadened to include clinical outcomes (e.g., hospital-acquired infection, falls, pressure ulcers), functional outcomes (e.g., performance of daily activities), quality-of-life outcomes (e.g., physical and mental health), and economic outcomes (e .g., direct, indirect, and intangible costs). EBP is an explicit process by which cl inicians conduct critical evidence reviews and examine the link between healthcar e practices and outcomes to inform decisions and improve the quality of ca re and patient safety. EBP and Accountability Nowhere is accountability a more sensitive topic than in healthcare. Kno wing that patient outcomes are linked to evidence-based interventions is crit ical for promoting quality patient care. Professional and regulatory organization s and third-party payers mandate the use of evidence-based practices. Addition ally, patients and families expect care to be based in best evidence. Public e xpectations that healthcare investments lead to high-quality results most likely wil l not diminish soon. In today’s environment, quality and cost concerns drive healthcare. Consumers expect professionals to deliver the best evidence- based care with the least amount of risk. Despite these mandates, much of the available data suggests that consume rs are not consistently receiving appropriate care (IOM, 2001). Nurses an d other healthcare professionals operate within an age of accountability (Leone nko & Drach-Zahavy, 2016); this accountability has become a focal point for healthcare (Pronovost, 2010). It is within this environment that nurses, physicia ns, public health scientists, and others explore what works and what does not. It i s within this context that nurses and other healthcare providers continue the jou rney to bridge research and practice. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 9 Governments and society challenge healthcare providers to base their pra ctices on current, validated interventions. In 2012, the National Center for Ad vanc – ing Translational Sciences at the National Institutes of Health was establish ed to accelerate the translation of scientific discoveries into practice (Austin, 2016). Nursing has responded to the groundswell of information by educating nur ses at every level to be competent practitioners of EBP and to close the gap between research and practice (Melnyk et al., 2017). EBP provides a systematic approach to decision-making that leads to best prac – tices and demonstrates clinician accountability for the care they provid e. When the strongest available evidence is considered, the odds of doing the ri ght thing at the right time for the right patient are improved. Given the complexity of linking research and clinical practice, EBP provides the most useful framework t o trans – late evidence into practice. The Healthcare Clinician’s Role in EBP EBP encompasses multiple sources of knowledge, clinical expertise, and p atient preference. Because of their unique positions and expertise, nurses and other healthcare providers often play a pivotal role in generating questions a bout patient care and safety. This, along with the fact that practice questions and concerns often cross disciplines, makes it critical to enlist an interpr ofessional team and to include patient and family input as part of the process. Thu s, clinicians need to develop the necessary knowledge and skills to not onl y participate in the EBP process but also serve as leaders of interdiscipl inary teams seeking best practices to improve patient care. These leaders also play a vital role in modeling and promoting a culture that supports the use of collaborati ve EBP within the organization and in ensuring that the necessary resources (e .g., time, education, equipment, mentors, and library support) are in place to fac ilitate and sustain the process. The JHEBP model is an effective and efficient process for conducting EBP. The model has been used in many institutions and has been embraced by frontline nurses, pharmacists, occupational therapists, and many other disciplines. The tools developed as part of the model enable the t eam to use a step-by-step process for successfully completing an EBP project. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 1 Evidence-Based Practice: Context, Concerns, and Challenges 10 Summary This chapter defines EBP and discusses the evolution that led to the c ritical need for practice based on evidence to guide decision-making. EBP creates a c ulture of critical thinking and ongoing learning and is the foundation for an envi ronment in which evidence supports clinical and operational decisions, and decis ions related to improvements in learning. EBP supports rational decision-maki ng, reducing inappropriate variation in practice and making it easier for cl inicians to do their job. EBP is an explicit process that facilitates meeting the needs of patients and delivering care that is effective, efficient, equitable, patient-centered, safe, and timely (IOM, 2001). References American Physical Therapy Association. (2020). 100 milestones of physical therapy . https:// centennial.apta.org/home/timeline/ Austin, C. P. (2016). 2016 director’s messages . National Center for Advancing Translational Sciences. https://ncats.nih.gov/director/message2016 Cochrane, A. L. (1972). Effectiveness and efficiency: Random reflections on health services. Nuffield Provincial Hospitals Trust. Cochrane Collaboration. (2016). About Cochrane. http://www.cochrane.org/about-us Curry, S. H. (2018). Translational science: Past, present, and future. BioTechniques, 44(2S). https:// doi.org/10.2144/000112749 Dang, D., & Dearholt, S. (2012). Johns Hopkins Nursing evidence-based practice: Model and guidelines (2nd ed.). Sigma Theta Tau International. EBSCO Publishing. (2020). CINAHL Plus Full Text. https://www.ebsco.com/products/research- databases/cinahl-plus-full-text Estabrooks, C. A. (1998). Will evidence-based nursing practice make practice perfect? Canadian Journal of Nursing Research , 30 (1), 15–36. Hanney, S. R., Castle-Clarke, S., Grant, J., Guthrie, S., Henshall, C., Mestre -Ferrandiz, J., Pistollato, M., Pollitt, A., Sussex, J., & Wooding, S. (2015). How long does biomedical research take? Studying the time taken between biomedical and health research and its translation into products, policy, and practice. Health Research Policy and Systems , 13 (1). https://doi. org/10.1186/1478-4505-13-1 Horsley, J., Crane, J., & Bingle, J. (1978). Research utilization as an organ izational process. Journal of Nursing Administration , 8(7), 4–6. https://doi.org/10.1097/00005110-197807000-00001 Horsley, J. A., Crane, J., Crabtree, M. K., & Wood, D. J. (1983). Using research to improve nursing practice. Grune & Stratton. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 11 Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. The National Academies Press. Institute of Medicine. (2003). Health professions education: A bridge to quality. The National Academies Press. JBI. (2020). Our history. https://joannabriggs.org/our-history Leonenko, M., & Drach-Zahavy, A. (2016). “You are either out on the court, or sitting on the bench”: Understanding accountability from the perspectives of nurses and nursing managers. Journal of Advanced Nursing , 72 (11), 2718–2727. https://doi.org/10.1111/jan.13047 Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2017). Implementing the evidence-based practice (EBP) competencies in healthcare . Sigma Theta Tau International. National Library of Medicine. (2020). MEDLINE: Overview. https://www.nlm.nih.gov/bsd/medline. html Nightingale, F. (1858). Notes on matters affecting the health, efficiency, and hospital administration of the British Army . Harrison & Sons. https://wellcomelibrary.org/item/ b20387118#?c=0&m=0&s=0&cv=88&z=-1.2809%2C-0.0462%2C3.5618%2C1.8022 Pronovost, P. J. (2010). Learning accountability for patient outcomes. JAMA , 304 (2), 204–205. https://doi.org/10.1001/jama.2010.979 Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 1 Evidence-Based Practice: Context, Concerns, and Challenges Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:55:30. Copyright © 2021. Sigma Theta Tau International. All rights reserved.
A critical component of any change project is an evaluation of the stakeholders and determination of an effective communication plan to support successful implementation of the evidence-supported chan
Why be concerned about creating a supportive environment for evidence-based practice (EBP)? The most obvious answer is that new evidence is continually surfacing in nursing and medical environ – ments. Practitioners must incorporate the tremendous amount of newly generated knowledge into their daily routines for their practices to be evidence-based, yet there is a continuing well-documented delay in implementing new knowledge into practice environments. The dy – namic and competitive US healthcare environment requires healthcare practitioners who are accountable to provide efficient and effective care. This environment also mandates continuous improvement in care processes and outcomes. Healthcare, provided within the struc – ture of a system or an organization, can either facilitate or inhibit the uptake of best evidence. EBP requires the creation of an environ – ment that fosters lifelong learning to increase the use of evidence in practice. Because of the emphasis on quality and safety, many healthcare orga – nizations have created strategic initiatives for EBP. Current national 2 Creating a Supportive EBP Environment Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 14 pay-for-performance initiatives—both voluntary and mandatory—provide reim – bursement to hospitals and practitioners for implementing healthcare pra ctices supported with evidence. Consumer pressure and increased patient expecta tions place an even greater emphasis on this need for true evidence-based prac tice. In an often-cited study, McGlynn et al. (2003) reported that Americans receive only about 50% of the healthcare recommended by evidence. A 2018 study found that only 8% of American adults age 35 and older received all recommende d high-priority clinical preventive services, based on recommendations by the U.S. Preventive Services Task Force and Advisory Committee on Immunization Prac – tices (Borsky, 2018). Even with the increased emphasis on EBP, the majority of hospitals and practitio – ners are not implementing the available evidence and guidelines for care in their practices (Lehane et al., 2019). This suggests an even greater imperat ive to build infrastructure that not only supports EBP but also infuses it into pract ice envi – ronments. Founded in 1970 as the Institute of Medicine (IOM), the National Acade my of Medicine (NAM) is one of three academies that make up the National Aca demies of Sciences, Engineering, and Medicine (the National Academies) in the United States. As part of a restructuring of the National Academies in 2015, th e IOM became NAM. Four previous IOM reports have called for healthcare profess ion – als to focus on evidence-based practice: ■ Crossing the Quality Chasm (2001) called for the healthcare system to adopt six aims for improvement and 10 principles for redesign. The report recommended that healthcare decision-making be evidence-based to ensure that patients receive care based on the best scientific evid ence available, and that the evidence is transparent to patients and their families to assist them in making informed decisions. ■ Health Professions Education: A Bridge to Quality (2003) described five key competencies for health professionals: delivering patient-centered care, working as part of interprofessional teams, focusing on quality improvement, using information technology, and practicing evidence- based medicine. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 15 ■ Roundtable on Evidence-Based Medicine (2009) brought medical researchers and clinicians together to set a goal that by the year 2020, 90% of clinical decisions would be supported by accurate, timely, and up-to-date clinical information, and reflect the best available eviden ce—a goal that, unfortunately, healthcare professionals did not met. ■ The Future of Nursing: Leading Change, Advancing Health (2011) urged that schools of nursing ensure that nurses achieve competency in leadership, health policy, systems improvement, teamwork and collaboration, and research and evidence-based practice. A new type of healthcare worker exists now: one educated to think critic ally and not to simply accept the status quo. Generation Y, otherwise referred to as millennials, and Generation Z (socialmarketing.org/archives/generations -xy- z-and-the-others) question current practices, and, “We’ve always done it that way” is no longer an acceptable response. They want evidence that wha t they are doing in the workplace is efficient and effective. These new gener ations are pushing the profession away from practice based on tradition and past pr actices that are unsupported by evidence. This push requires that evidence suppo rt all clinical, operational, and administrative decision-making. This compelling need for EBP in the healthcare environment requires prop er planning, development, and commitment. This chapter: ■ Explains how to choose an EBP model for use in the organization ■ Describes leadership strategies to cultivate EBP ■ Explores how to create and facilitate a supportive EBP environment ■ Describes how to overcome common implementation barriers ■ Discusses how to sustain the change Choosing an EBP Model It is critically important to establish a standardized approach to EBP i nquiry in the organization. A standardized approach and choosing a model assure s Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 16 the team that appropriate methods are used to search, critique, and synt hesize evidence when considering a change or improvement in systems, processes, and practice. A standardized approach facilitates implementation of best pra ctices both clinically and administratively; identifies and improves cost com ponents of care; fosters outcomes improvement; and ensures success of the EBP initi ative. Any EBP model or framework being reviewed for adoption should be careful ly evaluated for: ■ Fit, feasibility, and acceptability of the model with the vision, mission, philosophy, and values of the organization ■ Educational background, leadership, experience, and practice needs of staff ■ Presence of any partnerships for the EBP initiative, such as with school s that provide education for health professionals or collaboration with other professions, such as medicine, pharmacy, or nutrition ■ Culture and environment of the organization ■ Availability and access to sources of evidence internal or external to th e organization The leadership team should appoint a group to champion the EBP process a nd review models using the characteristics in this list and other organizat ional agreed-on criteria. Criteria for model review may include identifying st rengths and weaknesses, evaluating assumptions, verifying ease of use, ensuring applicability for all clinical situations, reviewing examples of use and dissemination, and securing recommendations of other users. Creating and Facilitating a Supportive EBP Environment Successful infusion of evidence-based practice throughout the organizati on must focus on four key strategies: ensuring committed organizational leadersh ip, establishing the culture, building capacity, and creating sustainability. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 17 Ensuring Committed Organizational Leadership Choosing the appropriate model to guide the systematic adoption of EBP a cross health professions and the organization is important; however, research has consistently found that supportive leadership is an essential component of the healthcare context that influences the successful implementation and u ptake of EBP. Leadership’s role is to create a supportive environment, empower clinicians, and be responsive to the tenets of EBP (Välimäki et al., 2018; Warren et al., 2016). Evidence indicates that committed leadership cultivates the organization al con – text, work culture, and practice environment; encourages a spirit of inq uiry, and enhances EBP across the organization, which results in improved outc omes (Dang et al., 2015; Pittman et al., 2019; Shuman et al., 2020). Frontline leaders, and nurse managers specifically, play a key role in organiza – tional climates that foster and promote EBP implementation by supporting , en – couraging, and engaging the staff to drive change (Aasekjær et al., 2016; Kueny et al., 2015). When leaders are actively involved and frequently consulted, the success of implementation, sustainability, and a stable infrastructure are more likely. When there is a lack of leader engagement, the change-and-transition process is more reactive than proactive, and the infrastructure and sustainability over time is less certain. Greenhalgh et al. (2004) describe three styles for managing t he transi – tion, change, and adoption of an innovation such as EBP: ■ Leaders “let it happen” by communicating a passive style where, fo r example, small pockets of staff may self-organize to explore and create their own process for engaging in EBP. ■ Leaders “help it happen” when a formal group such as advanced prac tice clinicians, acting as change champions, have invested in and defined a n approach to EBP and have to negotiate for support and resources to implement it. Still, the leader is pulled into the process by change rat her than leading it. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 18 ■ The “make it happen” approach is intentional, systematic, planned, and fully engages all leaders in the process to ensure adoption, spread, and sustainability. The highest level of discipline-specific leaders’ support and visib ility is paramount. The staff must see behaviors to advance the goal of infusing, building, and sustaining an evidence-based practice environment. The organization’s senior leadership can support EBP efforts best by modeling the practice and ensuring that all administrative decision-making is evi dence- based. For example, if the organization’s leaders ask middle managers for evi – dence (both organizational data and the best available research and non research evidence) to support important decisions in their areas of responsibili ty, it is more likely that staff at all levels will also question and require evid ence for their practice decisions. Additionally, all organizational departments’ clinical and administrative standards (policies, protocols, and procedures) nee d to reflect best evidence and source citations. For example, at Hopkins, the infecti on con – trol department implemented a policy regarding the use of artificial fi ngernails. Nurse managers (NM) were challenged with how to hold staff accountable for this change in policy, and subsequently, the senior leaders convened a group of NMs to conduct an EBP project on this topic. As a result, these managers were then armed with the best evidence on the risks associated with use of ar tificial nails and had direct experience with the EBP process and how it can stre ngthen administrative practice. With such leadership examples and activities, verbal and nonverbal EBP language and behaviors becomes a part of everyday activiti es and establishes an evidence-based culture. Finally, the leader can further model support for EBP by participating in EBP change activities. For example, if the plan is to offer EBP education to the man – agement group, the senior leader can attend and introduce the session by dis – cussing the organization’s vision of EBP. The leader’s presence demonstrates the commitment to EBP and its value to the organization. Participating also gives the senior leader an appreciation for the process, including the time an d resource commitment necessary for the organization to move toward an evidence-bas ed practice. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 19 To move the evidence-based practice initiative forward, the organization’ s senior leadership must ensure that the appropriate infrastructure is available and sup – ported. This organizational infrastructure consists of human and materia l re – sources and a receptive culture. Establishing the Organizational Culture Establishing a culture of practice based on evidence is a leadership-dri ven change that fundamentally challenges commonly held beliefs about practice. This transformational change in culture typically occurs over a period of thr ee to five years. During this time, leadership action builds EBP into the values, b eliefs, norms, language, and structure of the organization and caregiving units through a planned and systematic approach. Schein (2004) defines organizational culture as “patterns of shar ed basic assump – tions that were learned by a group as it solved its problems of external adaption and internal integration, that has worked well enough…to be taught to new members as the correct way to perceive, think, and feel in relationship to these problems” (p. 17). Thus, culture—a potent force operating below the surface—guides, c onstrains, or stabilizes the behavior of group members through shared group norms (Sc hein, 2004). Although organizations develop distinct cultures, subcultures al so operate at the unit or team level and create a context for practice. Embedding a culture based on evidence requires that leaders at all levels explicitly challen ge tradition, set expectations, model the use of evidence as the basis for decisions, and hold all levels of staff accountable for these behaviors. The visible and tangible work of establishing a culture supportive of EB P re – quires revisiting the vision for use of best evidence in practice, the E BP strategic plan, identifying and exploiting the use of mentors and informal leaders , and overcoming barriers. A tangible way to signal a change to a culture of evidence-based practic e and lay the foundation for leadership commitment is in a clear and specific mi ssion state – ment. This statement should include three key points: Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 20 ■ Speak to the spirit of inquiry and the lifelong learning necessary for evidence-based practice ■ Address a work environment that demands and supports the healthcare team members’ accountability for practice and decision-making ■ Include the goal of improving patient care outcomes through evidence- based clinical, operational, and administrative decision-making See Box 2.1 for an example of a mission statement from The Johns Hopkins Hospital (JHH) department of nursing. At JHH, the vice president of nu rsing and the directors wanted to ensure that the revisions in the mission resonat ed with and had meaning for the staff. After revising the document, they hosted an open forum with staff selected from all levels in the nursing department to p rovide input and feedback on the philosophy. This process highlighted the importance of this change, communicating leader commitment to EBP and to the part t hat staff would have in this change and transition. Box 2.1 Excerpts From The Johns Hopkins Hospital Department of Nursing Mission At The Johns Hopkins Hospital, we integrate the science of nursing, clin ical knowledge, nursing judgment, and passionate commitment to quality care w ith the art of nursing, honoring patients’ trust that they will be cared for with integrity and compassion. In our practice… we are experts in the specialized treatment of illnesses; we pursue quality outcomes, advocating in the best interest of our patie nts; we embrace the responsibility of autonomous practice and commit to a collaborative approach to patient care; we seek, appraise, and incorporate the best evidence to support our practice; we master the application of healthcare technology; Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 21 Developing a Strategic Plan Supportive and committed executive-level leadership must be involved in the creation and development of an evidence-based practice environment. To operationalize the vision and mission statements and build capacity fo r implementation of EBP, the organization’s leaders must develop a strategic plan to identify goals and objectives, time frames, responsibilities, and an evaluation process. The plan also requires a commitment to allocate adequate resour ces to the EBP initiative, including people, time, money, education, and mentoring. Leaders should implement a strategic goal for evidence-based practice at all levels of the organization. As the initiative rolls out, leaders need to check the pulse of the organization and be prepared to modify the strategy as necessary. They should identify potential barriers to implementation, have a plan to red uce or remove them, and support the project directors and change champions in e very way possible. Figure 2.1 outlines the essential elements of a strategic plan for initial implementation of EBP. As EBP develops over time, the content of the strategic plan should reflect the maturation of the program. • Vision • Leadership readiness • Organizational readiness • Select project champion/lead • Select project team • Select mentors • Select model Y ear I Strategic Plan • Budget • Identify knowledge, skills, abilities staff will need • Develop format, design, content of educational program • Pilot use of model Y ear II Build Competency • Job descriptions • Committees • Orientation • Policies, protocols • Ongoing staff education • Internal and external dissemination Y ear III Formalize Structure Figure 2.1 Elements of a strategic plan. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 22 Identifying and Developing Mentors and Informal Leaders Mentors and change champions have an important role in assimilation of E BP into the organizational culture. They provide a safe and supportive envi ronment for staff to move out of their comfort zone as they learn new skills and competencies. Informal leaders influence the staff at the unit or depa rtmental level. The presence and influence of both roles is a key attribute for sustainability and building capacity within staff. Because EBP is a leadership-driven c hange, leaders should identify and involve both formal and informal leaders ear ly and often in creating the change and transition strategies so that they can serve as advocates rather than opponents for the change and model its use in prac tice. Leadership must identify and select mentors with care, choosing them fro m across the organization—different roles, levels, and specialties. Con sider who within the organization has the knowledge and skills to move an EBP init iative forward, can offer the best support, and has the most at stake to see th at EBP is successful. When building the skills and knowledge of mentors, consider such questions as, “How will the mentors be trained? Who will provide the initial training? How and by whom will they be supported after their training is com – plete?” As the activities to build an EBP environment increase, leade rship needs to diffuse education and mentoring activities throughout the staff. The key to success is to increase buy-in by involving as many staff as possible to champion the EBP process by focusing on a problem that is important to them. Organizations can develop mentors in many ways. Initially, if the organization has not yet developed experts within their staff, it can find mentors through collaborative opportunities outside of the organization, such as partner ships with schools or consultation with organizations and experts who have developed models. After internal expertise is established, the implement ation of EBP throughout the organization results in a self-generating mechanis m for developing mentors. For example, members of committees who participate in EBP projects guided by a mentor quickly become mentors to other staff , committees, or groups who are engaged in EBP work. EBP fellowships are another way to develop mentors; the fellow gains skills to lead and cons ult with staff groups within their home department or throughout the organization . Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 23 Evidence indicates that, when facing a clinical concern, clinicians pref er to ask a colleague rather than search a journal, book, or the internet for the an swer. Col – leagues sought out are often informal leaders, and evidence indicates th at these informal leaders—opinion leaders and change champions—are effectiv e in chang – ing teams’ behaviors if used in combination with education and perfor mance feedback (Titler, 2008). Formal leaders differ from informal leaders in that formal leaders have position power, whereas informal leaders’ power is derived from their status, expertise, and opinions within a group. Opinion leaders are the go-to persons with a wide sphere of influence whom peers would send to represent them, and they are “viewed as a respected sou rce of in – fluence, considered by [peers] as technically competent, and trusted t o judge the fit between the innovation [EBP] and the local [unit] situation. …[ O]pinion lead – ers’ use of the innovation [EBP] influences peers and alters group norms” (Titler, 2008, pp. 1–18). Change champions have a similar impact, but they di ffer in that although they practice on the unit, they are not part of the unit staff. They circu – late information, encourage peers to adopt the innovation, orient staff to innova – tions, and are persistent and passionate about the innovation (Titler, 2008). The identification of champions can occur at two levels. The first i s at the orga – nizational level. These include, for example, clinical specialists, adva nce practice providers, and departmental subject matter experts as change champions. The second group of champions is at the departmental level and includes depa rtmental members whom the staff view as role models for professional practice and who can hold staff accountable. They are clinicians committed to clinical in quiry and, many times, are initially identified because of their interest in the topic or issue for an EBP project or because they are skillful collaborators and team p layers. The critical role of mentors and informal leaders in facilitating EBP an d translating the evidence into practice has been the focus of significa nt work (Dearholt et al., 2008; Titler, 2008). Mentoring and facilitation are needed throughout the EBP process to help healthcare team members be successful and to promote excellence (Bisset et al., 2016). Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 24 Overcoming Barriers to Fostering EBP Culture One ongoing responsibility of leadership is to identify and develop a pl an to overcome barriers to the implementation and maintenance of an EBP environment. Leaders must not underestimate this responsibility and must be a visible part of the implementation plan. Those involved in EBP have repeatedly cited time constraints as a barrie r that prevents implementation of EBP and the continued use of an inquiry model for practice. Providing clinical release time to staff participating in an E BP project is essential. Experience shows that staff need time to think about and disc uss the EBP project; to read the latest evidence; and to appraise the strength ( level and quality) of that evidence. Reading research and critiquing evidence is challenging and demanding work for clinicians and requires blocks of time set aside. EBP, an essential professional responsibility, cannot be done in stolen moments away from patients or in brief, 15-minute intervals. Healthcare team members require uninterrupted time away from the clinical unit. A lack of supportive leadership for EBP is another major barrier to the creation and maintenance of an EBP environment. Senior leaders must incorporate E BP into their roles and normative behavior. To create a culture of organizational support for EBP, the day-to-day language must be consistent with using evidence and be a part of the organizational values. That is, leaders must talk t he talk— making a point to ask, “Where is the evidence?” Leaders must also walk the walk, demonstrating daily a regard for evidence in their actions and beh aviors. Does the organization value science and research and hold its staff acco untable for using the best evidence in practice and clinical decision-making? Do leaders expect that routine decisions be based on the best possible data and evi dence, or do practitioners default to experience or history, financial restrictions, or even emotion? Do leaders themselves use the best evidence available for admin istrative decision-making? Does the organizational chart reflect a leader for de partments such as research and quality improvement? To whom do they report? Are these roles centralized or decentralized in the organizational structure? Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 25 A lack of organizational infrastructure to support EBP is another significant bar – rier. Resources—in terms of people, money, and time—require negotiation and allocation to support the initiative. Staff must be able to access libra ry resources, computers, and current evidence in online database resources. Experts, s uch as the champions and mentors, must also be part of the available infrastruc ture. Healthcare team members themselves can be a significant barrier to implement – ing EBP. They often lack the skills, knowledge, and confidence to read result s of research studies and translate them into practice. Some also may resi st EBP through negative attitudes and skepticism toward research. In some organ iza – tions, staff may feel they have limited authority to make or change prac tice deci – sions and are skeptical that anything can result from the pursuit of evi dence. An – other potential barrier is the nature of the interprofessional relations hips among disciplines, specialists, subject matter experts, and physicians. Lack of communication is a common barrier to implementation of any change but is particularly detrimental to EBP initiatives. To overcome this barrier, EBP teams can design a communication plan for an EBP initiative. As the staf f de – velops EBP and approaches the clinical environment with critical thinkin g, they want to know that what they are doing is valued. The staff expects leade rs to be responsive and open to their concerns or questions during implementation of the change. Staff will take ownership of the change if they sense that their leaders are partners in the change process. A final barrier is lack of incentives, recognition, or rewards in the organization for engaging in EBP projects. Leaders should assess whether the organiza tion’s systems nurture or limit EBP work and whether an accountability-based en viron – ment exists. Establishing an EBP environment and continuing EBP project work is challenging and requires a level of commitment on the part of all inv olved. The leadership team should understand the need for—and include incent ives to foster—meaningful work and professional development of staff as part of the EBP implementation process. These are crucial discussion points during t he plan – ning, implementation, and maintenance of the change. Barriers are best d ealt with through prevention and planning to assess and identify staff needs. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 26 Leading Culture Change and Managing Transition A key factor for success when undergoing a culture change is that leader s and those assigned to implement the change understand the difference between change and transition (see Table 2.1) and how to lead change and manage transitions (Bridges & Bridges, 2017); this understanding provides ins ights on how to overcome the barriers discussed earlier. Table 2.1 Definitions of Change and Transition Change An event that has a defined start and ending point and occurs external to us Transition An emotional or psychological process that occurs internally— inside the hearts and minds of staff as they come to grips with the new way of doing things Change is an event that has clear and tangible start and stop points. Fo r example, a staff-led EBP project finds that patients and families pref er clinical staff to wear color-coded scrub wear to distinguish among team members. Based on this evidence, leaders decide to change to standard colors for scrub wear for all clinical staff. This is change—it begins with selecting colors for clinicians and ends when staff begin wearing the new scrubs. Transition, on the other hand, involves “letting go” of something familiar, valued, or treasured, which generates a feeling of loss. When staff are labeled “resistant to change,” it is more accurately the transition they are resisting—the emotional process. Though change can take place in a short period, the time trajectory for transitions is different for each person and defined by their emotiona l state at any given moment. Therefore, to understand why some staff may resist cha nge, leaders of the change have to understand what staff will have to let go of when standardizing scrub wear. The scope and complexity of the change and the amount of spread determin es the amount of planning for change and transition. Some changes may consi st of simple, straightforward communication or educational “fast facts” on a device Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 27 such as switching from use of a flutter valve to an incentive spiromet er on a post-operative surgical unit. On the other hand, the change may be compl ex, multifaceted, and hospital-wide, such as implementation of a nurse-manag ed heparin protocol that affects nurse and physician responsibilities and w orkflow across the hospital. In either situation, knowing the difference between change and transition is important to success. Strategies for Managing Transitions Strategies for managing change are concrete and guided by tactical proje ct plans such as those outlined in Appendix A. However, when change activities spark resistance, it is a clue that the staff are dealing with transition—t he human side of the change. Resistance to change is how feelings of loss manifest, an d these are not always concrete. Losses may be related to attitudes, expectation s, assumptions—all of which make up staff comfort zones and provide them with a sense of routine and familiarity in what they do every day. One way to head off resistance is to talk with staff about what they fee l they stand to lose in doing things a new way—in other words, assess their losses. An – other strategy to help staff move through the transition is to describe the change in as much detail as possible and to be specific so that staff can for m a clear pic – ture of where the transition will lead, why the change is needed and res ults if the change is not made, and what part the staff play. In assessing loss, leaders need to think of individuals and groups that will be affected by the change b oth direct – ly and downstream of the practice, system, or process that is being chan ged. Be – cause transitions are subjective experiences, not all staff will perceiv e and express the same losses. Examples of the range of losses include competence, rou tines, relationships, status, power, meaning to their work, turf, group membership, and personal identity (Bridges & Bridges, 2017). Specific strategies to address these transitions include: ■ Talk with staff openly to understand their perceptions of what is ending. Frontline clinicians have enormous wisdom, and what they see as problems with the change should be respected and tapped into by valuing rather than judging their dissent. Do this simply, directly, and Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 28 with empathy. For example, say, “I see your hesitation in supporting the new scrub wear decision. Help me understand why.” In the end, staff are likely to move through the transition more quickly if given the chance t o talk openly about their losses. ■ Because culture is local, tailor how the change is implemented to the context of the caregiving unit where staff work; staff need to own this action locally. This is one reason that informal leaders and change champions are important. ■ Clarify what is staying the same to minimize overgeneralization and overreaction to the change. ■ After acknowledging the loss, honor the past for what staff has accomplished. Present the change as a concept that builds on this past. One way to do this is with symbolic events or rituals that can be powerful markers of honoring the past. For example, staff may create a quilt or collage of pieces or patterns of their scrub wear or write on a large poster in the break room to mark what they are letting go. ■ It is human nature for staff to complain first, before they accept the new way of doing things. Avoid arguing about the statements you hear, because it shuts down communication; rather, liberally use your active listening skills. Understanding is more important than agreement. Be transparent and let staff know when you do not know the answer; commit to finding out. Change teams should not underestimate the significance of communicatio n in the change-and-transition process. Communication is essential in buil ding broad support at both the organizational and local levels. A key strateg y is to be transparent and say everything more than once. Because of the amount of information staff receive, they need to hear it multiple times before th ey begin to pay attention. Bridges and Bridges (2017) recommends a rule of six times, six different ways, focused at the local level in explicit terms. For st aff to see the outcome of the change and move through the transition, you need to f ollow these four communication guidelines: Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 29 1. Describe clearly where you are going with the change; if people under – stand what the purpose is, and the problem that led to the change, they will be better able to manage the uncertainty that comes with transi – tion. 2. One outcome of communication is to leave staff with a clear, specific picture of what things will look like when the change is completed: What will the new workflow be? How will it look? What will it feel like? Who are the new players? 3. Explain the plan for change in as much detail as you have at the time; be transparent—if you don’t know something, say so, and always fol – low with when, or what you will need, to answer their question at a later time. 4. People own what they create, so let staff know what you need from them, what part they will have, and where they will have choices or input. Building Capacity Building capacity refers to arming staff with the knowledge, skills, and resources to procure and judge the value of evidence and translate it into practic e. EBP education and direct practice gained through work on interprofessional t eams is the most effective strategy to build competency to use and apply EBP. Developing EBP Knowledge and Skills The most popular format for EBP education programs at Hopkins is the one -day workshop. The morning session covers EBP concepts, the JHEBP Model and Guidelines, and evidence searching and appraisal techniques. In the afte rnoon, attendees critique and appraise the evidence for an EBP question and dec ide, as a group, whether a practice change is warranted based on the evidence available to them. Hopkins experts have successfully implemented the one -day workshop in many settings outside of Hopkins, including in rural, commun ity, and nonteaching hospitals and other large academic medical centers. Table 2.2 outlines the educational topics and objectives for the one-day workshop. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 30 Table 2.2 One-Day Workshop Topics and Objectives Subject Area Objectives Introduction to Evidence-Based Practice Explain the origins of EBP Discuss the importance of EBP Define EBP Guidelines for Implementation Describe the JHEBP Model Discuss plans for using the model Explain the steps in the process Discuss how to develop an answerable question Appraising Evidence Describe the different levels of evidence Determine where to look for evidence Searching for Evidence Discuss library services: ■ How to have a search run by the library ■ How to order articles ■ How to do a basic literature search Appraising the Evidence Application Provide explanation of the evidence appraisal forms Facilitate group appraisal or evaluation of assigned articles Discuss level of appraisal and quality of each article Complete individual and overall evidence summary forms Summarizing the Evidence and Beyond Facilitate discussion of synthesis of the evidence Determine whether practice changes are indicated based on the evidence Describe fit, feasibility, and acceptability of practice change Discuss how the practice change can be implemented Discuss how changes can be evaluated Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 31 Access to Information and Library Services Librarians’ skills in searching, organizing, and evaluating informati on can contribute to furthering the development of EBP and creating a positive impact on interprofessional staff and patient outcomes (Marshall et al., 2013) . Almost all of the respondents (95%) said the information found with the help of librarians resulted in better-informed clinical decisions. Findings from their study showed that the availability and use of library and information resource s and services consistently affected how clinicians gave advice to patients, h andled patient care problems (diagnoses, tests, treatments, medication errors) , avoided adverse events, and saved time. Over the last several decades, a number of researchers have conducted re views of the literature to examine how healthcare professionals acquire and us e infor – mation to inform practice (Davies & Harrison, 2007; Hurst & Mickan, 201 7; Isham et al., 2016; Spenceley et al., 2008). Findings indicate that hea lth profes – sionals prefer face-to-face meetings, collegial discussion, and print ma terials over evidence-based resources. The preference for informal learning sources i s in part a result of common barriers clinicians face, such as clinical demands, l ack of availability of current resources and time, limited searching skills, an d issues with online resources. If an organization provides easy access to resources f or practice inquiry and creates an expectation of their use, EBP can flourish. Tho se who do not provide such resources must address this critical need. The Johns Hopkins Evidence-Based Practice Model implementation team foun d that indicators of success of an environment supportive of inquiry inclu ded the following conditions: ■ Staff has access to reference books and the internet on the patient care unit. ■ Journals are available in hard copy or online. ■ A medical and nursing library is available. ■ Knowledgeable library personnel are available to support staff and assis t with evidence searches. ■ Other resources for inquiry and EBP are available. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 32 Interprofessional Collaboration In today’s team-focused healthcare environment, interprofessional collaboration for the evaluation and dissemination of evidence in the healthcare work setting is a high priority because many practice changes involve all members of the healthcare team, administrators, and policymakers. A conference held in February 2011 in Washington, DC—sponsored by the Health Resources and Services Administration (HRSA), Josiah Macy Jr. Foundation, Robert Wood Johnson Foundation, ABIM Foundation, and Interprofessional Education Collaborative (IPEC)—brought together more than 80 leaders from var ious health professions to review “Core Competencies for Interprofessional Collaborative Practice” (IPEC Expert Panel, 2011). The meeting’s agenda focused on creating action strategies for the core competencies to trans form health professional education and healthcare delivery in the United Stat es. Competency Domain 4 supported the need for interprofessional teams to pr ovide evidence-based care: “Apply relationship-building values and the prin ciples of team dynamics to perform effectively in different team roles to plan and deliver patient-/population-centered care that is safe, timely, efficient, effective, and equitable” (p. 25). When developing EBP teams, consider interprofes sional participation and the identification and development of EBP mentors fr om all the health professions. It is widely recognized that education to develop skills and knowledge a bout EBP is essential for today’s healthcare professional (IOM, 2003). This education is important at all levels of education. The development of a collaborat ion with schools that prepare and educate health professionals is mutually reinfo rcing. The practice organization can provide real-life EBP questions for the st udents to use in their research courses. As a course assignment and using the q uestions provided by the collaborating school, students search and critique the a vailable evidence to inform the practice question from free literature databases such as CINAHL Plus, Cochrane, Embase, PsycINFO, PubMed, and Web of Science. The students prepare a summary of the evidence, synthesize the findings, a nd make general recommendations for the practice organization to evaluate and co nsider translating to their practice. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 33 EBP is an essential competency for all health professionals and is no lo nger op – tional (IOM, 2003). Programs require that students understand the EBP process and use results to generate new knowledge for the profession. The collab ora – tion between or among disciplines provides a strong team approach to imp rove clinical practice. Practice questions, issues, and concerns are often ge nerated at the point of care by frontline clinicians. These practice questions resu lt in evi – dence search, critique, and synthesis of findings. However, when the synthesis of findings is not strong or clear, it requires further evaluation. This evaluation often involves a pilot study to generate new evidence. The involvement o f PhD- prepared research healthcare practitioners is critical to the design of research and generation of new knowledge. This collaborative approach to practice bet ween doctorate-prepared professions is the goal for practice organizations. Finally, collaboration with health profession schools can also foster the creat ion of faculty practice arrangements and faculty development. The developmen t of a faculty practice can take many shapes, including both direct and indir ect prac – tice collaborations, depending on the needs of the practice organization and the school. A collaboration can be beneficial for both groups by effective ly integrat – ing EBP concepts into curricula and for professional development in the organi – zation. Sustaining the Change At the beginning of an EBP strategic initiative, the organization’s leaders must support and sustain a change in how the organization approaches its work . The leaders, mentors, and change champions and those responsible for the initiative must continually listen to the staff and be responsive to the ir comments, questions, and concerns. For EBP to be fully adopted and integrated into the organization, staff must feel that changing practice will improve qualit y of care and make a difference in patients’ lives. The passion will be palpabl e when EBP becomes a part of everyday practice. Therefore, sustaining the change re quires an infrastructure that aligns staff expectations and organizational stru ctures with the strategic vision and plan for a culture based on evidence. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 34 Setting Expectations for EBP Setting role expectations for EBP through development of job description s, orientation programs, and performance evaluation tools is a first step in developing human capital for EBP and for hardwiring the culture of pract ice based on evidence. These personnel tools should be developed or revised to emphasize the staff’s responsibility and accountability for making administrative and practice decisions based on best evidence to improve patient care ou tcomes and processes. The tools must be consistent across the employment contin uum. For example, job descriptions should state professional expectations in terms of everyday performance and measurement of competence. The orientation should introduce professionals to how the organization develops and eval uates competencies. The performance evaluation tool should measure the level o f performance on the standards and competencies for EBP practice. Committee Structure Standing professional practice committees and their members take on the roles of EBP change champions and mentors. Each committee serves a different b ut important role for implementing EBP throughout the organization. Profess ional practice committee structures are designed to promote excellence in pati ent care, practice, education, and all forms of inquiry (EBP, quality improvement, research) by: ■ Recruiting and retaining a diverse professional staff ■ Establishing evidence-based standards of care and practice ■ Promoting interprofessional inquiry ■ Advancing professional growth and development Table 2.3 describes EBP functions for the department of nursing professio nal practice committees. Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 35 Table 2.3 Department of Nursing Committee Functions Related to EBP Committee Functions EBP Steering Committee Establishes strategic initiatives for EBP within and external to Johns Hopkins Health System and Johns Hopkins University School of Nursing Clinical Quality Improvement Committee Promotes evidence-based improvements in systems and processes of care to achieve safe, high-quality patient outcomes Leadership Development Committee Recommends and implements innovative evidence-based strategies for management and leadership practice Research Committee Supports discovery of new knowledge and translation into nursing practice Standards of Care Committee Promotes, develops, and maintains evidence-based standards of care Standards of Practice Committee Promotes, develops, and maintains evidence-based standards of professional practice Communication Plan A communication plan should be an integral part of both the EBP process and its sustainability. The plan should address: ■ The goals of the communication ■ Target audiences ■ Available communication media ■ Preferred frequency ■ Important messages Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 36 Minimally, the goals for an EBP communication plan should focus on staff to increase awareness of the initiative, educate staff regarding t heir contribution, highlight and celebrate successes, and inform staff about EBP activities throughout the organization. Consider developing an EBP websi te within the organization’s intranet. This website can be an excellent vehicle for communicating EBP information, including questions under consideration, projects in progress or completed, outcomes, and available EBP education al opportunities. The website can also serve as a snapshot and history of a n organization’s EBP activities and can be helpful when seeking or maintaining Magnet designation. Finally, the communication plan can use online surveys to involve staff by aski ng opinions about potential or completed work, maintaining a finger on th e pulse of initiatives, and developing EBP “messages.” Messages can target th e communica – tion, link the initiative to the organization’s mission, and give a consistent vision while providing new and varied information about the initiative. After movement toward a supportive EBP environment begins, the biggest c hal – lenge is to keep the momentum going. To sustain the change, the staff must own the change and work to sustain it in a practice environment that values critical thinking and uses evidence for all administrative and clinical decision- making. When resources are allocated to an EBP initiative, some may raise questi ons about expenditures and the costs related to EBP. To sustain the work of and value to the organization, EBP project work needs to reflect and align with the organization’s priorities. It is helpful to identify EBP projects that improve safety or solve risk management problems; address wide variations in practice o r in clinical practice that are different from the community standard; or sol ve high- risk, high-volume, or high-cost problems. Consider asking these question s: “Is there evidence to support the organization’s current practice? Are these the best achievable outcomes? Is there a way to be more efficient or cost-effec tive?” Im – provements or benefits to the organization could result in any of thes e important areas if EPB work identified best practices to improve outcomes of car e, decrease costs, or decrease risks associated with the problem. Sustaining the cha nge also involves developing an evaluation plan to identify process and outcome p erfor – Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 37 mance measures that monitor implementation, commitment, and results. The measures should determine the usefulness, satisfaction, and success of the EBP environment. Are the initiatives changing or supporting current prac tice? What best practices or exemplars have resulted? Has the organization sav ed money or become more efficient? What performance data shows that this is mak – ing a difference to the organization? The evaluation plan should include a time – line and triggers that would signal when a modification of the plan is necessary. Summary We have learned many lessons in the development, implementation, and continual refinement of the JHEBP Model and Guidelines. The need to cr eate a supportive EBP environment is one of the most important lessons. Essen tial to that effort is recognition of the importance of capacity building for EBP. Supportive leaders’ help at all levels is essential to establish a cu lture of EBP, including the expansion of infrastructure and the allocation of resource s— such as time, money, and people—to sustain the change. Leaders set priorities, facilitate the process, and set expectations. The development of local m entors and champions contributes to the successful implementation of EBP and he lps overcome barriers and resistance to EBP. A culture of critical thinking and ongoing learning creates an environme nt where evidence supports clinical and administrative decisions, ensuring the hi ghest quality of care by using evidence to promote optimal outcomes, reduce in appro – priate variation in care, and promote patient and staff satisfaction. Working in an EBP environment changes the way healthcare team members think about a nd approach that work. As the staff develop expertise in the EBP process, t heir pro – fessional growth and engagement begins a personal and organizational tra jectory leading to evidence-based decisions, a higher level of critical review o f evidence, and engagement as valued contributors in the interprofessional team. References Aasekjær, K., Waehle, H. V., Ciliska, D., Nordtvedt, M. W., & HjaImhult, E. (2016). Management involvement—A decisive condition when implementing evidence-based pra ctice. Worldviews on Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment 38 Evidence-Based Nursing , 13(1), 32–41. https://doi.org/10.1111/wvn.12141 Bissett, K., Cvach, M., & White, K. (2016). Improving competence and c onfidence with evidence- based practice among nurses: Outcomes of a quality improvement project. Journal for Nurses in Professional Development , 32(5), 248–255. https://doi.org/10.1097/NND.0000000000000293 Borsky, A., Zhan, C., Miller, T., Ngo-Metzger, Q., Bierman, A., & Meyers, D. (2018). Few Americans receive all high-priority, appropriate clinical preventive services. Health Affairs , 37(6), 925–928. https://doi.org/10.1377/hlthaff.2017.1248 Bridges, W., & Bridges, S. M. (2017). Managing transitions: Making the most of change (4th ed.). Da Capo Press. Dang, D., Melnyk, B., Fineout-Overholt, E., Ciliska, D., DiCenso, A., Cu llen, L., & Stevens, K. (2015). Models to guide implementation and sustainability of evidence- based practice. In B. M. Melnyk & E. Fineout-Overholt (Eds), Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Wolters-Kluwer Health. Davies, K., & Harrison, J. (2007). The information seeking behavior of doctors: A review of the evidence. Health Information Library Journal , 24 (2), 78–94. https://doi.org/10.1111/j.1471- 1842.2007.00713.x Dearholt, S. L., White, K. M., Newhouse, R., Pugh, L. C., & Poe, S. (20 08). Educational strategies to develop evidence-based practice mentors. Journal for Nurses in Staff Development , 24(2), 53–59. https://doi.org/10.1097/01.NND.0000300873.20986.97 Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommend ations. The Milbank Quarterly, 82(4), 581–629. https://onlinelibrary.wiley.com/doi/full/10.1111/j.0887- 378X.2004.00325.x Hurst, D., & Mickan, S. (2017). Describing knowledge encounters in hea lthcare: A mixed studies systematic review and development of a classification. Implementation Science , 12(35), 2–14. Institute of Medicine (US) Committee on Quality of Health Care in Amer ica. (2001). Crossing the quality chasm: A new health system for the 21st century . National Academies Press. Institute of Medicine Committee on the Health Professions Education Summ it. (2003). A. C. Greiner & E. Knebel (Eds.), Health professions education: A bridge to quality . National Academies Press. Institute of Medicine. (2009). Roundtable on evidence-based medicine. National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK52847/ Institute of Medicine Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2011). The future of nursing: Leading change, advancing health . National Academies Press. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Interprofessional Education Collaborative. Isham, A., Bettiol, I. A., Hoang. H., & Crocombe, L. (2016). A systema tic literature review of the information-seeking behavior of dentists in developed countries. Journal of Dental Education , 80(5), 569–577. Kueny, A., Shever, L. L., Mackin, M. L., & Titler, M. G. (2015). Facilitating the implementation of evidence-based practice through contextual support and nursing leader ship. Journal of Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professi onals, Fourth Edition 39 Healthcare Leadership , 7, 29–39. https://doi.org/10.2147/JHL.S45077 Lehane, E., Leahy-Warren, P., O’Riordan, C., Savage, E., Drennan, J., O’Tuathaigh, C., O’Connor, M., Corrigan, M., Burke, F., Hayes, M., Lynch, H., Sahm, L., Heffernan, E., O’Keeffe, E., Blake, C., Horgan, F., & Hegarty, J. (2019). Evidence-based practice education for healthcare professions: An expert view. BMJ Evidence-Based Medicine , 24(3), 103–108. https://doi. org/10.1136/bmjebm-2018-111019 Marshall, J. G., Sollenberger, J., Easterby-Gannett, S., Morgan, L. K., Klem, M. L., Cavanaugh, S. K., Oliver, K. B., Thompson, C. A., Romanosky, N., & Hunter, S. (2013). The value of library and information services in patient care: Results of a multisite study. Journal of Medical Library Association , 101 (1), 38–46. https://doi.org/10.3163/1536-5050.101.1.007 McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. A. (2003). The quality of health care delivered to adults in the United S tates. New England Journal of Medicine , 348 (26), 2635–2645. https://doi.org/10.1056/NEJMsa022615 Pittman, J., Cohee, A., Storet, S., LaMothe, J., Gilbert, J., Bakoyannis , G., Ofner, S., & Newhouse, R. (2019). A multisite health system survey to assess organizational c ontext to support evidence-based practice. Worldviews on Evidence-Based Nursing , 16(4), 271–280. https://doi. org/10.1111/wvn.12375 Schein, E. H. (2004). Organizational culture and leadership (3rd ed.). Jossey-Bass. Shuman, C. J., Ehrhart, M. G., Torres, E. M., Veliz, P., Kath, L. M., VanAntwerp, K., . . . Aarons, G. A. (2020). EBP implementation leadership of frontline nurse manager s: Validation of the Implementation Leadership Scale in acute care. Worldviews on Evidence-Based Nursing, 17 (1), 82–91. Spenceley, S. M., O’Leary, K. A., Chizawsky, L. L. K., Ross, A. J., & Estabrooks, C. A. (2008). Sources of information used by nurses to inform practice: An integrative review. International Journal of Nursing Studies , 45(6), 954–70. https://doi.org/10.1016/j.ijnurstu.2007.06.003 Titler, M. G. (2008). The evidence for evidence-based practice implementatio n. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses . AHRQ Publication No. 08-0043. Agency for Healthcare Research and Quality. Välimäki, T., Partanen, P., & Häggman-Laitila, A. (2018). An integrative review of intervent ions for enhancing leadership in the implementation of evidence-based nursing. Worldviews on Evidence- Based Nursing , 15(6), 424–431. https://doi.org/10.1111/wvn.12331 Warren, J. I, McLaughlin, M., Bardsley, J., Eich, J., Esche, C. A., Kropkowski, L., & Risch, S. (2016). The strengths and challenges of implementing EBP in healthcare systems. Worldviews on Evidence-Based Nursing , 13(1), 15–24. https://doi.org/10.1111/wvn.12149 Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved. 2 Creating a Supportive EBP Enviroment Dang, Deborah, et al. Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals, Fourth Edition, Sigma Theta Tau International, 2021. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/ucf/detail.action?docID=6677828. Created from ucf on 2022-09-27 20:56:26. Copyright © 2021. Sigma Theta Tau International. All rights reserved.