Describing the Problem for an Evidence-Based Practice Improvement Project: A Missing Ingredient

Abstract

C o-authoring this issue's evidence-based practice (EBP) column is particularly exciting for me because I am co-authoring it with one of my Doctor of Nursing Practice (DNP) students. This is a first because Pace just began its DNP program in fall 2008. Robert is a member of the first cohort. He and I have been dialoguing from his first semester in the program about EBP. At first he was reluctant to completely embrace this model of clinical decision making because he felt that it lacked elements of patient-centered care. After much conversation, reading, and reflection, his beliefs evolved and he began to see the interconnectedness of EBP, primary health care, and cultural competence (which happen to be the 3 Pillars for Pace's DNP Program).Readers of this column in RTNP may have realized how my thinking about the EBP paradigm has been evolving over the past few years. Previous columns in RTNP such as "EBP by Any Other Name is Still a Rose" ( Levin, 2008 ) and "Walk Before You Run" ( Levin, 2009 )-were instrumental in helping me hone my thinking into what has become the Evidence-Based Practice Improvement (EBPI) Model ( Levin et al., 2010 ), a model that merges the best of EBP and performance improvement (PI) into a simple and relevant model that may guide improvement efforts. EBPI was originally introduced as the model that students would use for their EBPI doctoral projects.After two semesters in which we were immersed in EBPI as a model for DNP projects, and after a course in evaluation in which the importance of stakeholder involvement in any organizational initiative was stressed, Robert came up with the idea that we need to include stakeholder interview data as an important component of problem description. Although the importance of stakeholder involvement has been emphasized in primary health care ( World Health Organization, 1978 ), public health initiatives (Centers for Disease Control, 1999), PI ( Langley et al., 2009 ), and evaluation ( Patton, 2008 ) literature, it has not become part and parcel of an EBP or EBPI framework. This column explores the notion of including stakeholder involvement as a stated and important component of any organizational improvement effort.

Maintaining Perioperative Normothermia: Sustaining an Evidence‐Based Practice Improvement Project

“…A lthough several authors previously have discussed factors related to the sustainability of improvement initiatives, [1][2][3][4][5] there are few published accounts of projects that have attained sustainability. At the outset of any improvement project, four important factors are necessary to promote its sustainability: strong leadership, support of stakeholders, nurse champions, and modifiable projects that are in alignment with the organization's vision, mission, and goals.…”