Question

sample of clinical inquiry research.

Answer 1

Clinical Research and Practice Collaborative: An Evidence-Based Nursing Clinical Inquiry Expansion

Abstract

Introduction: Implementation and sustainment of evidence-based practices (EBPs) are common challenges faced by healthcare organizations. The Clinical Research and Practice Collaborative, an evidence-based initiative implemented at a large Military Treatment Facility, addresses EBP implementation and sustainment by expanding the culture of nursing clinical inquiry and broadening nursing research efforts to include EBP. The evidence-based intervention of scheduled, intentional, intraprofessional collaboration between PhD nurse scientists and advanced practice registered nurses as compared to previous methods of spontaneous, consultative collaboration, focuses on developing support for nursing research and EBP initiatives. Materials and Methods: A 2-year pre- and 2-year post-implementation timeframe compared outcomes (proposals, publications, posters) from individual and collaborative nursing research and EBP initiatives. Results: Although nursing research initiatives remained stable, research publications and posters were reduced by 63%, EBP initiatives grew 450%, EBP publications and collaborative nursing initiatives for both research and EBP increased. Additionally, EBP Council membership rose 300%, and an intraprofessional cadre was formed during the implementation. Conclusions: Intentionally scheduled collaboration between PhD nurse scientists and advanced practice registered nurses is a promising model to promote an expanded culture of nursing clinical inquiry and should be considered for medical facilities seeking to enhance EBP and nursing research efforts.

INTRODUCTION

The Institute of Medicine’s ambitious 2020 goal for at least 90% of clinical decisions to be evidence-based includes clinical interventions and practices delivered by nurses.¹ Although many nurses believe that evidence-based practice (EBP) is essential to nursing practice, there are a host of barriers that prevent implementation of EBP. Common barriers, such as lack of EBP knowledge, limited skillsets, few mentors, little support, and limited resources, prevent implementation across institutions.^2,3 A systematic review summarized findings from 31 publications focused on EBP attitude, knowledge, skills, strengths, and barriers and concluded that despite more than 20 years of effort, EBP implementation remains deficient.⁴ Moreover, a study of civilian chief nurse executives revealed enduring EBP organizational barriers such as low-level funding and prioritization within organizations despite chief nurse executives beliefs that EBP produces high-quality care.⁵ Recent literature suggests that EBP provides a mechanism to attain the quadruple aim⁶ which addresses improved patient care, improved population health, reduced healthcare costs, and care-team well-being.⁷ The Military Health System’s quadruple aim includes the first three civilian aims but focuses on increased readiness as the fourth aim,⁸ hence maintaining the importance of EBP as a relevant healthcare strategy.

Background

Problem

The purpose of this article is to describe an Air Force Medical Service (AFMS) nurse scientist (NS) evidence-based initiative, referred to as the Clinical Research and Practice Collaborative (CRPC). The CRPC addresses the problem of organizational barriers to EBP implementation and sustainment at a large military medical treatment facility (MTF) and advances the culture of nursing clinical inquiry by expanding nursing research efforts to include facilitation and support for nursing EBP amidst increasing readiness requirements and military health system reformations. The long-term goal of the CRPC is improved patient outcomes produced by a clinical inquiry concept that generates new nursing clinical evidence through nursing research and translates nursing clinical evidence into nursing practice through EBP implementation and sustainment.

AFMS and Nursing Clinical Inquiry

The AFMS vision is “Trusted Care” founded on a culture of safety, patient-centeredness, leadership engagement, and continuous process improvement to be a highly reliable organization.⁹ EBP is a cornerstone for highly reliable organization and magnet-recognized organizations.¹⁰ The Advanced Practice Registered Nurse (APRN) is considered vital for ensuring EBP¹¹ and has specific competencies to aid in developing EBP skills.¹² The American Association of Colleges of Nursing provides a consensus model for the licensure, accreditation, certification, and education of APRNs, defined as graduate-level educated nurses who are nationally certified in one of four roles (certified registered nurse anesthetist, certified nurse-midwife, clinical nurse specialist [CNS], or certified nurse practitioner [CNP]) and provide direct patient care across the continuum of health from illness to wellness.

The AFMS Nurse Corp (NC) is ~3,200 strong with over 12% of the force comprised of privileged (credentialed) Master’s and Doctoral prepared APRNs. In addition to the privileged APRNs, there is an unaccounted-for number (estimated as ~90–100 by the prior Air Force (AF) CNS Consultant) of CNSs in specialty roles, such as Obstetric, Pediatric, Adult, Acute Care, Community/Public Health. The majority of AFMS APRNs manage a full empanelment of clinic patients, surgical caseloads, and inpatients, providing direct patient care across the healthcare spectrum. Consequently, APRNs have limited time as EBP experts, to lead EBP efforts outside of their direct provision of care.

Although the APRN role focuses on “translating” scientific evidence into daily practice, the primary role of the Ph.D. prepared NS is designing and executing military-unique and operationally relevant research to “generate” scientific evidence for rapid translation into practice by military and civilian healthcare professionals. The NS community constitutes 0.03% (10 positions) of the entire AFMS NC. Balancing readiness requirements and patient care requirements consume most NC resources (budget, time, staff), limiting the ability to conduct, implement, and sustain EBP. Recent trends incorporate EBP as a component of clinical inquiry and subsequently extend the role of the NS to include evidence translation in addition to evidence generation.

Local Nursing Clinical Inquiry

David Grant USAF Medical Center (DGMC) is a Joint Commission-accredited teaching hospital and the largest of 76 MTFs in the AFMS. Supported by over 2,000 personnel, DGMC serves an eligible beneficiary population of >368,000 patients, providing care for more than 424,000 outpatients and 5,600 inpatient admissions annually. Much like the overall AFMS nursing strength, DGMC typically fluctuates between 80 and 85% in nursing manpower. The Clinical Investigation Facility, responsible for leading and executing clinical research in support of DGMC staff and 14 graduate health education (GHE) programs, includes two distinctly different NS positions: Director of Nursing Research (responsible for all nursing-related clinical inquiry, secondary support of GHE research, and developing a personal portfolio of nursing research) and Director of Clinical Research (responsible for eight GHE clinical research support and administrative staff, support of all GHE research, secondary assistance of nursing clinical inquiry, and developing a personal portfolio of nursing research).