Introduction
The aim of this paper is to present the results of the implementation of a nursing project directed by evidence-based practice (EBP). The paper will discuss an educational intervention, evaluate its impact, and identify activities necessary to sustain the change and support quality improvement.
Evidence-Based Scholarly Project
The project’s main objective was to design and implement an educational intervention based on the best current evidence that addresses the problem of heterosexism and homophobia in nursing staff at the University of Miami Hospital Emergency Room. A long-term aim of the project was to change the registered nurses’ (RN) stance on the subject matter, thereby improving the overall health outcomes of the lesbian, gay, bisexual, and transgender (LGBT) community in Miami.
The Iowa Model of Evidence-Based Practice to promote Quality Care guided the implementation of the project. The model is based on “an algorithm with defined decision points and feedback loops” (Schaffer, Sandau, & Diedrick, 2012, p. 1198). The model was selected because it is intuitively understandable and has been successfully applied in a variety of settings (Brown, 2014; Melnyk & Fineout-Overholt, 2011).
Key Stakeholders
The project team was led by the principal investigator—a former employee of the department. The LGBT community of Miami was the key stakeholder in the project. Staff RNs at the University of Miami Hospital Emergency Room where another group of stakeholders whose unique perspectives were taken into consideration during the implementation stage of the project.
A Practice Change
After identifying a clear need for a practice change, an educational intervention was developed and implemented. The intervention was based on the following Malcolm Knowles’s five assumptions that underpin the scholar’s andragogy: “adult learners are self-directed learners, adult learners bring a wealth of experience to the educational setting, adults enter educational settings ready to learn, adults are problem-centered in their learning, and adults are best motivated by internal factors” (Roebuck, Moran, MacDonald, Shumer, & McCune, 2015, p. 412).
Given that adult learners are motivated by their internal factors, a needs assessment survey was used to better understand the RN staff’s individual preferences for receiving information (Roebuck et al., 2015).
The educational intervention involved male and female RNs from the Emergency Department who participated in the study. The intervention took the form of a lecture with a PowerPoint presentation that served as a visual aid and helped to enhance the delivery of a speaker’s message.
Implementation
A problem trigger was identified as a paucity of knowledge about the needs of LGBT community members. Following the approval of the department’s manager and a thorough literature review, the change team developed an educational intervention. The lecture was piloted in front of an expert panel consisting of five RNs from the department and five members of a not-for-profit LGBT community organization—Equality Florida.
The group of experts reviewed the educational materials and provided feedback, which was used for improving the content and delivery of the lecture. The educational training was conducted in one of the organizational classrooms that was equipped with a digital projector and provided a positive learning environment.
Evaluation
The impact of the educational intervention on structure and process was assessed with the help of a quasi-experimental design. This methodology is invaluable for making a descriptive causal inference (Campbell & Stanley, 2015). The data collection was conducted with the help of two instruments: an LGBT knowledge test and an attitude scale. The test consisted of 10 true/false questions. The attitude scale was based on an approach to measuring an individual’s attitude proposed by Likert (Ary, Jacobs, Irvine, & Walker, 2013).
The participants were offered a choice of six responses to twenty statements that had a neutral point. The RNs were encouraged to express how much they agree or disagree with the LGBT-related statements. Answers were interpreted by using a median summary. The distribution of answers was presented in a bar chart.
The independent variable for the project was an educational intervention. The dependent variables included: a decrease in reporting LGBT-related prejudice among RNs of the Emergency Department and an increase in the number of RNs who have a demonstrably better understanding of the needs of the LGBT community. Descriptive statistics were used to analyze the results of the intervention. Paired sample t-tests were used to determine whether differences in pre-and post-intervention responses could be attributed to the educational training. Statistical results revealed that the post-intervention RNs showed a 4.64 percent increase in their mean score. It means that the intervention helped to change both the LGBT knowledge and attitude of the RNs.
Sustaining the Change
In order to sustain the change in the department, it is necessary to choose an EBP mentor who will be responsible for moving the staff to a culture of best practice (Melnyk & Fineout-Overholt, 2011). The change in sustainability can also be improved by involving the unit’s leaders in discussing the results of the intervention (Fleiszer, Semenic, Ritchie, Richer, & Denis, 2016). In addition, the leaders will have to facilitate the creation of the environment in which the RNs can learn from one another.
Conclusion
The paper outlined the results of the implementation of the EBP project and discussed its impact and activities aimed at sustaining the change. The evaluation of the project showed that the lecture had helped to improve both the LGBT knowledge and attitude of the RNs.
References
Ary, D., Jacobs, L., Irvine, K., & Walker, D. (2013). Introduction to research in education. Boston, MA: Cengage Learning.
Brown, C. (2014). The Iowa Model of Evidence-Based Practice to promote Quality Care: An illustrated example in oncology nursing. Clinical Journal of Oncology Nursing, 18(2), 157-159.
Campbell, D., & Stanley, J. (2015). Experimental and quasi-experimental designs for research. Victoria, Canada: Ravenio Books.
Fleiszer, A., Semenic, S., Ritchie, J., Richer, J., & Denis, M. (2016). Nursing unit leaders’ influence on the long-term sustainability of evidence-based practice improvements. Journal of Nursing Management, 24(1), 309-318.
Melnyk, B., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing & healthcare: A guide to best practice (2nd ed.). Philadelphia, PA: LWW.
Roebuck, H., Moran, K., MacDonald, D., Shumer, S., & McCune, R. (2015). Assessing skin cancer prevention and detection educational needs: An andragogical approach. The Journal of Nurse Practitioners, 11(4), 410-416.
Schaffer, M., Sandau, K., & Diedrick, L. (2012). Evidence-based practice models for organizational change: Overview and practical applications. Journal of Advanced Nursing, 69(5), 1197-1209.