NURS 6052 EVIDENCE- BASED PRACTICE
WHERE IN THE WORLD IS EVIDENCE-BASED PRACTICE?
March 21, 2010, was not EBP’s date of birth, but it may be the date the approach “grew up” and left home to take on the world.
When the Affordable Care Act was passed, it came with a requirement of empirical evidence. Research on EBP increased significantly. Application of EBP spread to allied health professions, education, healthcare technology, and more. Health organizations began to adopt and promote EBP.
In this Discussion, you will consider this adoption. You will examine healthcare organization websites and analyze to what extent these organizations use EBP.
To Prepare:
Review the Resources and reflect on the definition and goal of EBP.
Choose a professional healthcare organization’s website (e.g., a reimbursing body, an accredited body, or a national initiative).
Explore the website to determine where and to what extent EBP is evident.
Post a description of the healthcare organization website you reviewed. Describe where, if at all, EBP appears (e.g., the mission, vision, philosophy, and/or goals of the healthcare organization, or in other locations on the website). Then, explain whether this healthcare organization’s work is grounded in EBP and why or why not. Finally, explain whether the information you discovered on the healthcare organization’s website has changed your perception of the healthcare organization. Be specific and provide examples.
NURS 6052 LEARNING RESOURCES
Required Readings
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Chapter 1, “Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry” (pp. 7–36
Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot. (https://search.proquest.com/docview/1972281107?accountid=14872) Journal of Nursing Education, 56(12), 707–708. doi:10.3928/01484834-20171120-01
Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing Essay, 13(2), 172–75. doi:10.1111/wvn.12126
Kim, S. C., Stichler, J. F., Ecoff, L., Brown, C. E., Gallo, A.-M., & Davidson, J. E. (2016). Predictors of evidence-based practice implementation, job satisfaction, and group cohesion among regional fellowship program participants (https://search.ebscohost.com/login.aspx? Worldviews on Evidence-Based Nursing, 13(5), 340–348. doi:10.1111/wvn.12171
Melnyk, B.M., Fineout-Overhold, E., Stillwell, S.B., & Williamson, K.M. (2010). Evidence-based practice step-by-step: The seven steps of evidence-based practice. American Journal of Nursing, 110(1), 51-53.
Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence-Based
Nursing, 11(1), 5–15. doi:10.1111/wvn.12021 Sikka, R., Morath, J. M., & Leape, L. (2015). The Quadruple Aim: Care, health, cost and meaning in work https://search.proquest.com/docview/1778837907?
NURS_6052_Module01_Week01_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeWrite a brief analysis of the connection between evidence-based practice and the Quadruple Aim. Your analysis should address how evidence-based practice might (or might not) help reach the Quadruple Aim, including each of the four measures of:· Patient experience· Population health· Costs· Work life of healthcare providers 85 to >76.0 pts
Excellent
The analysis clearly and accurately addresses in detail how evidence-based practice either supports or does not support the Quadruple Aim. … The analysis accurately and thoroughly explains in detail how the four measures of patient experience, population health, costs, and work-life of healthcare providers either supports or does not support the Quadruple Aim. … The analysis provides a complete, detailed, and specific synthesis of two outside resources reviewed on the four measures supporting or not supporting the Quadruple Aim. The response fully integrates at least two outside resources and two or three course-specific resources that fully support the analysis provided with credible and detailed examples. 76 to >67.0 pts
Good
The analysis accurately addresses how evidence-based practice either supports or does not support the Quadruple Aim. … The analysis accurately explains how the four measures of patient experience, population health, and work life of healthcare providers either supports or does not support the Quadruple Aim. … The analysis provides an accurate synthesis of at least one outside resource reviewed on the four measures supporting or not supporting the Quadruple Aim. The response integrates at least 1 outside resource and two or three course-specific resources that may support the analysis provided and may include some detailed examples. 67 to >59.0 pts
Fair
The analysis inaccurately or vaguely addresses how evidence-based practice either supports or does not support the Quadruple Aim. … The analysis inaccurately or vaguely explains how the four measures of patient experience, population health, and work life of healthcare providers either supports or does not support the Quadruple Aim. … The analysis provides an inaccurate or vague analysis of the four measures supporting or not supporting the Quadruple Aim with a vague or inaccurate analysis of outside resources. The response minimally integrates resources that may support the analysis provided and may include vague or inaccurate examples. 59 to >0 pts
Poor
The analysis inaccurately and vaguely addresses how evidence-based practice either supports or does not support the Quadruple Aim or is missing. … The analysis inaccurately and vaguely explains how the four measures of patient experience, population health, and work life of healthcare providers either supports or does not support the Quadruple Aim or is missing. … The analysis provides a vague and inaccurate analysis of the four measures supporting or not supporting the Quadruple Aim with a vague and inaccurate analysis of outside resources. The response fails to integrate any resources to support the analysis provided or is missing.
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The Integral Role of Evidence-Based Practice in Achieving the Quadruple Aim
The Quadruple Aim provides a framework for optimizing health system performance by simultaneously targeting four dimensions: improving patient experience, enhancing population health, reducing costs, and improving the work life of healthcare providers (Bodenheimer & Sinsky, 2014). As the US healthcare system grapples with rising costs, uneven quality, and clinician burnout, the Quadruple Aim offers guidance on how to enhance value and sustainability. However, transforming such a massive, complex system requires a systematic approach grounded in rigorous evidence regarding which interventions and innovations are most likely to be effective and scalable. This is where evidence-based practice (EBP) becomes integral to achieving the Quadruple Aim.
What is Evidence-Based Practice?
Evidence-based practice refers to the judicious, conscientious, and explicit use of current best evidence from well-designed studies in making decisions about the care of individual patients (Sackett et al., 1996). It aims to integrate individual clinical expertise with the best available external clinical evidence from systematic research. The core principles of evidence-based practice as defined by Sackett et al. (1996) include:
Identifying clinically relevant questions and converting them into an answerable structure
Tracking down the best evidence with which to answer the question
Critically appraising the evidence for its validity, impact, and applicability
Applying the results of this appraisal to clinical practice
Evaluating the effectiveness and efficiency in executing steps 1-4 and seeking ways to improve them both for next time
When well-executed, this problem-solving approach allows the integration of research evidence, clinical judgment, available resources, and patient values and circumstances (Melnyk & Fineout-Overholt, 2015). Doing so moves clinical decision-making beyond personal experience alone and closer to empirical knowledge regarding optimal interventions. As healthcare systems pursue large-scale change guided by the Quadruple Aim, embedding evidence-based practice across settings and specialties can enhance the likelihood of meaningful and sustainable improvements.
The Role of EBP in Achieving Quadruple Aim Goals
While the Quadruple Aim provides strategic direction, evidence-based practice offers tactical support regarding how to operationalize system-wide transformation. Examining each dimension of the Quadruple Aim framework reveals the integral role EBP plays as an engine for positive change (Melnyk & Gallagher-Ford, 2020).
Enhancing the Patient Experience
The patient experience encompasses quality of care, patient engagement, and satisfaction (AHRQ, 2017). Improving how patients perceive their healthcare journeys requires understanding factors that matter most to them and employing best practices to address those priorities. EBP facilitates this through direct integration of patient values into clinical decisions and a commitment to interventions shown to achieve outcomes aligning with patient goals. By ensuring patients consistently receive appropriate, effective, respectful, and compassionate care grounded in scientific evidence, EBP serves as a conduit for superior patient experiences across the continuum of care (Melnyk et al., 2016).
Improving Population Health
Beyond individual patients, optimizing the health status of entire communities and populations remains a central goal of healthcare reform. This requires a paradigm expanding beyond acute care to preventive care, community-based interventions, and addressing social determinants of health (Kindig & Stoddart, 2003). Applying evidence-based practice principles helps identify upstream protective and risk factors within populations as well as effective programming to shift outcomes in a positive direction. EBP also guides resource allocation toward evidence-based community health initiatives addressing prevalent issues from nutrition to substance abuse to injury prevention (Brownson et al., 2009). Employing scientific evidence to inform population health decisions and interventions enhances impact.
Reducing Costs
With U.S. healthcare costs projected to reach 20% of GDP by 2026 (CMS, 2017), evidence-based delivery models offering better value have become a fiscal imperative. Evidence-based practice promotes value through ensuring patients only receive high-value, cost-effective interventions shown to improve outcomes they care about (Melnyk et al., 2016). EBP also reduces practice variability which controls costs and avoids over-utilization or duplication. Evaluating services against formal cost-effectiveness thresholds steers limited resources toward evidence-based models delivering the highest value (McGinty & Anderson, 2008). Payment reforms which incentivize evidence-based care also bend the cost curve by rewarding outcomes over volume.
Improving Clinician Wellbeing
Finally, the Quadruple Aim targets enhancing professional fulfillment and resilience among healthcare providers as a key driver for broader system performance. However, clinician burnout has become an epidemic threatening the viability of healthcare professions (Han et al., 2019). Evidence-based practice offers solutions through standardizing care processes to reduce moral distress when best practices are not supported and empowering clinicians to deliver high-quality care aligned with their expertise and values (Melnyk et al., 2016). EBP also facilitates team-based care models which foster peer collaboration and support. Overall, grounding healthcare delivery and work environments in evidence-based principles fosters opportunities for clinicians to find greater meaning in their clinical practice.
Implementing Evidence-Based Practice at Scale
While the synergies between EBP and Quadruple Aim goals are clear, achieving system-wide transformation requires effectively implementing evidence-based models across diverse settings and populations. This demands a supportive infrastructure to nurture evidence adoption and ongoing utilization (Stetler et al., 2009). Core elements of an evidence-based practice environment include (Melnyk et al., 2016):
Leadership Prioritization of EBP: System leaders demonstrate clear and consistent prioritization of evidence-based practice in policies, procedures, and resource allocation.
EBP Mentors and Champions: Clinical and administrative champions provide mentorship and support for EBP project implementation.
Access to Evidence Sources: Point-of-care access exists to evidence databases and academic literature.
EBP Education and Training: Ongoing professional development trains clinicians in core evidence-based practice competencies.
Recognition and Rewards for EBP Efforts: Performance evaluations and incentive structures integrate evidence-based practice expectations and achievements.
Cultivating such an environment equips clinicians with knowledge, tools, and motivation to consistently incorporate evidence across the spectrum of care delivery. Aligned payment models which reward evidence-based care also facilitate large-scale adoption. With multifaceted organizational strategies in place, the clinical application of scientific evidence can permeate practice patterns to drive Quadruple Aim progress.
Conclusion
In conclusion, achieving the ambitious vision outlined in the Quadruple Aim requires grounding health system transformation efforts in the principles of evidence-based practice. EBP provides the vehicle through which research evidence can actively inform clinical decisions in the pursuit of better patient experiences, improved population health outcomes, controlled costs, and enhanced joy in practice among healthcare professionals. While barriers exist, cultivating a supportive infrastructure helps clinicians access, evaluate, integrate, and apply empirical evidence in ways aligned with Quadruple Aim goals. With concerted leadership commitment and a sound implementation approach, EBP represents the compass guiding the realization of a higher-value, more sustainable healthcare system prepared to fully embrace the 21st century.
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The role of Evidence-Based Practice (EBP) in achieving the Quadruple Aim in healthcare is crucial. EBP involves integrating the best available evidence with clinical expertise and patient values to make informed decisions about patient care. The Quadruple Aim focuses on enhancing patient experience, improving population health, reducing costs, and enhancing the work life of healthcare providers.
Connection between EBP and the Quadruple Aim
EBP plays a significant role in supporting the Quadruple Aim by:
Patient Experience: EBP ensures that care is based on the latest evidence, leading to better outcomes and improved patient satisfaction
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Population Health: By implementing evidence-based interventions, healthcare organizations can enhance population health outcomes and address public health challenges effectively
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Costs: EBP helps in reducing unnecessary medical procedures and healthcare costs by promoting efficient and effective care delivery
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Work Life of Healthcare Providers: Implementing EBP can lead to better job satisfaction among healthcare providers as it promotes quality care delivery, reduces errors, and enhances patient outcomes
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Impact of EBP on Nursing Policy and Practice
The establishment of Evidence-Based Practice Centers (EPCs) within healthcare systems has been instrumental in promoting EBP among nurses and improving patient care quality. These centers support the integration of evidence into decision-making processes, ultimately contributing to achieving the Quadruple Aim
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Examples of EBP Implementation
A study in Poland demonstrated that an educational intervention based on EBP led to a reduction in unnecessary medical procedures and healthcare costs in outpatient settings without compromising patient satisfaction
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The Magnet® program recognizes nursing excellence and promotes evidence-based nursing practices, aligning with the Quadruple Aim framework
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In conclusion, Evidence-Based Practice is a cornerstone in achieving the Quadruple Aim in healthcare by enhancing patient experience, improving population health outcomes, reducing costs, and supporting the well-being of healthcare providers. The integration of EBP into nursing policy and practice through initiatives like EPCs and programs like Magnet® plays a vital role in advancing quality care delivery and meeting the goals of the Quadruple Aim.
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Evidence-Based Practice and the Quadruple Aim: A Symbiotic Relationship
The landscape of healthcare delivery is undergoing a paradigm shift, moving towards a model that prioritizes not just individual patient care, but also population health, cost-effectiveness, and provider well-being. This multifaceted approach, known as the Quadruple Aim, presents a unique challenge and opportunity for the integration of evidence-based practice (EBP).
The Quadruple Aim: A Holistic Approach to Healthcare
The Quadruple Aim, introduced by the Institute for Healthcare Improvement (IHI) in 2016, encompasses four interconnected goals:
Improve patient experience: Enhance the quality and satisfaction of care received by patients.
Improve population health: Optimize the overall health of the population served by the healthcare system.
Reduce healthcare costs: Minimize the financial burden of healthcare delivery on both patients and the system itself.
Improve the work life of healthcare providers: Foster a work environment that promotes provider well-being and reduces burnout.
EBP: A Cornerstone for Achieving the Quadruple Aim
EBP, defined as the conscientious, explicit, and judicious use of current best evidence in making healthcare decisions (Melnyk & Fineout-Overholt, 2023), serves as a fundamental pillar for achieving the Quadruple Aim. By systematically integrating research findings into clinical practice, EBP can contribute to each of its four components:
Patient experience: EBP ensures that patients receive care grounded in the latest scientific evidence, potentially leading to improved clinical outcomes, reduced treatment variability, and ultimately, a more positive patient experience (Crabtree et al., 2016).
Population health: Implementing evidence-based preventive and public health interventions can significantly improve population health outcomes by addressing factors like chronic diseases, health disparities, and social determinants of health (Boller, 2017).
Cost reduction: EBP implementation has been linked to cost savings through various means, such as avoiding unnecessary tests and procedures, promoting efficient resource allocation, and optimizing treatment protocols (Melnyk et al., 2014).
Provider well-being: EBP empowers healthcare providers with the knowledge and tools to make informed decisions, potentially leading to increased job satisfaction, reduced burnout, and improved professional autonomy (Kim et al., 2016).
Challenges and Opportunities
Despite the potential benefits, integrating EBP into routine practice presents several challenges. These include:
Limited access to research resources: Clinicians may face difficulty accessing and critically appraising research evidence due to time constraints, lack of training, or limited institutional support.
Implementation barriers: Putting research findings into practice can be hindered by factors like organizational inertia, inertia, lack of infrastructure, and resistance to change.
Knowledge-practice gap: Bridging the gap between existing knowledge and its application in real-world clinical settings requires ongoing efforts in education, mentorship, and quality improvement initiatives.
Conclusion
The pursuit of the Quadruple Aim necessitates a multifaceted approach that prioritizes not just clinical outcomes, but also patient experience, population health, and provider well-being. EBP serves as a powerful tool in this endeavor, offering a systematic and evidence-based framework for decision-making. By overcoming the existing challenges and fostering a culture of continuous learning and improvement, healthcare systems can leverage EBP to achieve the Quadruple Aim and ultimately deliver high-quality, efficient, and patient-centered care.
Scholarly Bibliography
Boller, J. (2017). Nurse educators: Leading health care to the quadruple aim sweet spot. Journal of Nursing Education, 56(12), 707–708. [DOI: 10.3928/01484834-20171120-01]
Crabtree, E., Brennan, E., Davis, A., & Coyle, A. (2016). Improving patient care through nursing engagement in evidence-based practice. Worldviews on Evidence-Based Nursing, 13(2), 172–75. [DOI: 10.1111/wvn.12126]
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Melnyk, B. M., Gallagher-Ford, L., Long, L. E., & Fineout-Overholt, E. (2014). The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: Proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews
