Through nursing research, new knowledge is continually generated. However, new knowledge is useless if it is not applied with the purpose of enhancing patient care. The need to do so is urgent in light of adverse health care outcomes that continue to occur. Evidence-based nursing aims to bridge the wide gap between current knowledge and clinical practice that increases the likelihood of effectiveness, efficiency, and cost-efficiency (Stevens, 2013). It is a hallmark of quality nursing care highlighted by current health care reforms. The IOWA model is one of several frameworks used to facilitate EBP in nursing. It consists of seven steps that guide nurses in utilizing research evidence discussed below in the context of a health care quality issue.
Selecting a Topic
Patient falls are common but preventable causes of fractures, wounds, and other injuries in health care settings. It is also one cause of death. Estimates show that each year, around 500,000 cases of falls occur in hospitals alone (NPSF, 2013). There are internal and external factors contributing to a fall such as medication side-effects, dehydration, orthostatic hypotension, and the state of the physical environment. Hence, the magnitude of the problem requires effective and multidisciplinary prevention measures. Evidence-based prevention in hospital settings can be developed by locating relevant literature using the following key words: fall, prevention, and hospital.
Forming a Team
Instituting fall prevention measures represents a change in practice. A participative approach involving stakeholders has been shown to elicit buy-in and a greater commitment to change (Borkowski, 2009). For this reason, a team approach to prevention is likely to result in success. The team should be composed of representatives from the concerned disciplines – medicine, nursing, pharmacy, and physiotherapy. Representatives must be tasked to communicate the change within their respective departments or units, especially the specific roles that each discipline will play. The quality improvement officer should also be part of the team to make sure change is aligned with QI, credentialing, and strategic goals.
Retrieving Evidence
The team will hold brainstorming sessions that include the identification of available sources of evidence (Doody & Doody, 2012). The Cochrane library is a good database to use because it contains clinical trials and systematic reviews. Medline and CINAHL are good sources as well because they provide access to both quantitative and qualitative research on fall prevention. In nursing, qualitative data provide a holistic perspective of the issue such as practical considerations during implementation (Seers, 2012; Stevens, 2013). Meanwhile, the National Guidelines Clearinghouse is also a good resource because it is a repository of EBP guidelines and updates on the issue. It is helpful to create criteria for selecting studies that will guide the team as a single database search can yield hundreds of articles.
Grading the Evidence
After retrieving relevant articles, it is important to appraise each study and the entire body of evidence (Doody & Doody, 2012). Studies on fall prevention interventions vary in setting, population, methodology, and results. Each should be graded on the basis of effectiveness or the degree that the intervention leads to the achievement of intended outcomes. The criteria will also include appropriateness that pertains to compatibility with patients’ values and interests. Thirdly, feasibility must be considered in relation to organizational resources, culture, and buy-in. The Johanna Briggs Institute grading system consists of an A = strong evidence that warrants application (unequivocal), B = moderate strength of evidence also warranting application (credible), and C = not supported by evidence (unsupported) (JBI, 2011).
Developing an EBP Standard
The evidence appraisal and grading for specific fall prevention interventions determine their inclusion in the facility’s EBP standard. A grade of C will mean exclusion because of the lack of evidence supporting the intervention. The team will make these decisions thereby coming up with a comprehensive standard that will address the modifiable risk factors to patient falls and will be implemented through multidisciplinary collaboration. Current evidence supports patient assessment for fall risk and preventive interventions tailored according to level of risk (NICE, 2013). The team will identify fall risk assessment tools and the range of interventions to be employed by the health care team.
Implementing the Standard
Evaluation
Measurements will be taken after implementing the fall prevention standards. A comparison between post-implementation performance and the baseline provides a quantitative picture of the impact of EBP utilization in preventing patient falls. A reduction in patient fall rates and an increase in patient satisfaction are indicators of effectiveness and appropriateness. On the other hand, a high rate of staff compliance with protocols and in-service education are indicative of feasibility. Besides an outcome evaluation, a process evaluation is also in order and entails an assessment of the manner in which the fall prevention standards were created and implemented (Gardner, Gardner & O’Connell, 2013). The purpose is to inform similar undertakings in the future.
Conclusion
Utilizing research findings for evidence-based practice is a skill that must be learned in order to improve the quality of care and successfully adapt to health care reforms. The high incidence of patient falls in the hospital underscores the need for EBP. Using the IOWA model makes possible the efficient utilization of evidence for fall prevention. It breaks down the process into steps that nurses can follow which include selecting a priority clinical problem as well as organizing a team to spearhead the collective effort. The model further calls for retrieving and grading evidence from the literature that is a prerequisite to the development of fall prevention standards. The team will consequently implement the standards and evaluate the outcomes.
References
Borkowski, N. (2009). Organizational behavior in healthcare (2nd ed.). Massachusetts, MA: Jones and Bartlett Publishers.
Doody, C.M., & Doody, O. (2012). Introducing evidence into nursing practice: Using the IOWA model. British Journal of Nursing, 20(11), 661-664. Retrieved from http://www.researchgate.net/Introducing_evidence_into_nursing_practice_us
Gardner, G., Gardner, A., & O’Connell, J. (2013). Using the Donabedian framework to examine the quality and safety of nursing service innovation. Journal of Clinical Nursing, 23(1-2), 145-155. doi: 10.1111/jocn.12146.
Joanna Briggs Institute (2011). Joanna Briggs Institute reviewers’ manual: 2011 edition. Retrieved from http://joannabriggs.org/assets/docs/sumari/ReviewersManual- 2011.pdf
National Institute for Health and Care Excellence (2013). Falls: Assessment and prevention of falls in older people. Retrieved from http://www.guideline.gov/content.aspx?id=46931&search=fall+prevention
National Patient Safety Foundation (2014). Key facts about patient safety. Retrieved from http://www.npsf.org/for-patients-consumers/patients-and-consumers-key-facts-about- patient-safety/
Seers, K. (2012). Research made simple: Qualitative data analysis. Evidence Based Nursing, 15(1), 2. doi:10.1136/ebnurs.2011.100352.
Stevens, K.R. (2013). The impact of evidence-based practice in nursing and the next big ideas. The Online Journal of Issues in Nursing, 18(2). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodica ls/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Evidence-Based- Practice.html
Weaver, S.J., Lubomski, L.H., Wilson, R.F., Pfoh, E.R., Martinez, K.A., & Dy, S.M. (2013). Promoting a culture of safety as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158(5 Pt 2), 369-374. doi: 10.7326/0003-4819-158-5- 201303051-00002.
