Implementing Evidence-Based Practice Facilitators: A Case Series

Abstract

Background In 2017, the TriService Nursing Research Program completed a strategic planning session, which identified key barriers to implementing evidence-based practice (EBP) within the U.S. Military Health System (MHS) including a focus on readiness training and deployments, frequent staff moves for military members, and relatively junior nurses in clinical roles. To facilitate EBP at individual military treatment facilities (MTFs), an EPB Facilitator role was developed using an evidence-based model and based on validated EBP competencies. Methods This new role was implemented at four MTFs in 2018: Naval Medical Center Portsmouth, 59th Medical Wing at Joint Base San Antonio Lackland, Naval Medical Center San Diego, and David Grant USAF Medical Center at Travis Air Force Base. This case series provides a description of the initial implementation of this role. Results Common enablers and challenges were identified from the experiences at all four sites. These included the importance of incorporating efforts into existing organizational efforts and infrastructure; the value of nurse leaders inviting EBP facilitators to participate and engage in scheduled meetings and committees; the significance of engaging with existing quality, process improvement, and training initiatives; and the benefit of collaborating with advanced practice nurses within the organization. The common challenges for all EBP facilitators were the frequent staff turnover at all levels and a lack of standardization to review and approve EBP initiatives, which makes it difficult to navigate the complete process of project implementation and collaboration across sites. Another challenge has been the difficulty to measure the impact of this role at the MTF and MHS levels. Conclusions As EBP efforts continue and the program matures, it is anticipated that the outcomes from the individually completed projects, to include decreases in safety events, fiscal savings, and other improvements in organizational metrics, can be compiled to demonstrate the collective impact of these roles within the MHS.

Nurses' experience of integrating evidence‐based changes into their practice: A qualitative study

“…According to the participant's experience, despite the appropriate and accepting organizational atmosphere in the study departments and the follow-up and supervision of responsible people, including the head nurses, physicians and faculty members; The lower prioritization of managers at other levels such as clinical supervisors and their lack of information about EBP and the lack of regular monitoring have been the barrier to the implementing this process. Consistent with these findings, other studies have identified a lack of support for change (Dadich et al, 2015;Pericas-Beltran et al, 2014) and a lack of knowledge and skills in the EBP (Augustino et al, 2020;Clarke et al, 2021) as barriers to the implementing EBP. The value and priority of EBP implementation in the organization and appropriate monitoring and feedback from managers lead to the creation of a supportive organizational climate for change (Baird & Miller, 2015;Melnyk et al, 2010;Whiteside et al, 2016).…”

A Qualitative Force Field Analysis of Facilitators and Barriers to Evidence-Based Practice in Healthcare Using an Implementation Framework

“…For example, structural characteristics such as leadership engagement, support, and commitment (Albers et al, 2021;Bach-Mortensen et al, 2018;Bauer et al, 2015;Bergmark et al, 2018;Brown et al, 2014;Ecker et al, 2021;Flodgren et al, 2012;Li et al, 2018;Ogden et al, 2016;Quinn et al, 2019;Shuman et al, 2020;Theys et al, 2020) are frequent facilitators for EBP across settings, as are initial and ongoing education and skill building for clinicians (Albers et al, 2021;Bauer et al, 2015;Bergmark et al, 2018;Bernhardsson et al, 2017;Brown et al, 2014;Eisman et al, 2020;Keurhorst et al, 2015;Li et al, 2018;McNett et al, 2021b;Shuman et al, 2020;Tucker & Gallagher-Ford, 2019;Warren et al, 2016). In addition, unit-based champions or facilitators in local clinical groups can promote routine uptake of an EBP within specific settings, as these individuals often know vital factors to support implementation (Albers et al, 2021;Augustino et al, 2020;Bergmark et al, 2018;Bernhardsson et al, 2017;Brown et al, 2014;Newhouse et al, 2013;Pellecchia et al, 2018;Theys et al, 2020;van Rooijen et al, 2021). Likewise, a team-based approach (Flodgren et al, 2012;Quinn et al, 2019;…”

“…Barriers to EBP implementation often reflect the absence of one or more of the factors that facilitate routine implementation in clinical settings. For example, lack of knowledge or competencies in EBP (Augustino et al, 2020;Bernhardsson et al, 2017;Clarke et al, 2021;Garcia et al, 2021;Li et al, 2018;Ogden et al, 2016;Warren et al, 2016;Yoo et al, 2019), absence of leadership support (Augustino et al, 2020;Bergmark et al, 2018;Ecker et al, 2021;Garcia et al, 2021;Li et al, 2018;Quinn et al, 2019;Shuman et al, 2020), and lack of time/resources for EBP (Bernhardsson et al, 2017;Clarke et al, 2021;Flodgren et al, 2012;Garcia et al, 2021;Li et al, 2018;McNett et al, 2021b;Quinn et al, 2019) are barriers to EBP implementation. In addition, individual factors such as resistance to change (Bauer et al, 2015;Brown et al, 2014;Clarke et al, 2021;Ecker et al, 2021;Eisman et al, 2020;Flodgren et al, 2012;Quinn et al, 2019;Theys et al, 2020;Tucker & Gallagher-Ford, 2019) and poor collaboration (Bauer et al, 2015;Bergmark et al, 2018;Bernhardsson et al, 2017;Brown et al, 2014;Clarke et al, 2021;Garcia et al, 2021;Ogden...…”

“…In addition, individual factors such as resistance to change (Bauer et al, 2015;Brown et al, 2014;Clarke et al, 2021;Ecker et al, 2021;Eisman et al, 2020;Flodgren et al, 2012;Quinn et al, 2019;Theys et al, 2020;Tucker & Gallagher-Ford, 2019) and poor collaboration (Bauer et al, 2015;Bergmark et al, 2018;Bernhardsson et al, 2017;Brown et al, 2014;Clarke et al, 2021;Garcia et al, 2021;Ogden et al, 2016;Theys et al, 2020) hinder implementation efforts. Additional organizational factors have been identified as barriers for EBP implementation such as lack of standardized processes (Augustino et al, 2020;Garcia et al, 2021;Li et al, 2018;Newhouse et al, 2013), lack of financial support (Augustino et al, 2020;Flodgren et al, 2012;Garcia et al, 2021;Quinn et al, 2019), complex environments (Bauer et al, 2015;Brown et al, 2014;Ogden et al, 2016;Theys et al, 2020), absence of EBP mentors (Flodgren et al, 2012;Ogden et al, 2016), and persistent practice variation (Bernhardsson et al, 2017;Garcia et al, 2021;Li et al, 2018;Ogden et al, 2016).…”

“…A multitude of research within IS and other fields has identified common, persistent facilitators and barriers for implementation of EBP across sites and settings (Albers et al, 2021;Augustino et al, 2020;Bach-Mortensen et al, 2018;Clarke et al, 2021;Garcia et al, 2021;Li et al, 2018). While individuals or organizations may be knowledgeable about EBP and its importance, they may not have knowledge about the science of implementation, the requisite skills to implement, or be in an environment with a robust implementation culture.…”