links header


Connie White-Williams, PhD, RN, FAAN
University of Alabama-Birmingham Hospital

connie white-williamsEvidence based practice (EBP) is the process by which nurses and allied health professionals make clinical decisions based on the best and latest evidence, clinical expertise, and patient values. So, why don't we ring in more evidence for the New Year? This task requires the retrieval of available research published in our field which allows practice change to be based on evidence. Consequently, nurses and allied health professionals should have two New Year's resolutions on their "to do" list: 1) To publish research on the care of pre- and post-transplant and mechanical circulatory support device patients, and 2) To find evidence in the literature to support best clinical practice.

The Centers for Medicare Service (CMS) have provided guidelines and standards for transplant professionals. CMS requires nurses, pharmacists, and dieticians to have initial training and ongoing education to maintain the most current and best EBPs in transplant care. The clinical transplant coordinator, pharmacist, dietitian and others must be involved in all phases of transplant care. Consequently, knowledge and understanding of the definitions and processes of EBP along with how they are different from initiatives such as quality improvement and research are important to transplant nursing and allied health professionals.

There are several models of EBP including the Advancing Research and Clinical Practice through Close Collaboration (ARCC) model. This model has seven steps: cultivating the spirit of inquiry, asking the burning question, searching the literature, appraising the literature, integrating the change into practice, evaluating the outcomes, and disseminating the results. The steps of the EBP process begin with generating inquiry. Issues surrounding multidisciplinary care or the patient population arise every day in transplantation. For instance, in transplant patients, is individual teaching compared to group discharge teaching more effective in decreasing hospital readmissions after surgery? What is best practice for adherence to the medical regimen before and after transplantation? These questions could be raised by the nurse, dietician, pharmacist, physical therapist or social worker.

Research is the systematic inquiry which is specifically designed to develop, refine, and extend nursing and allied knowledge. The intent of nursing research is to answer questions and develop knowledge using a scientific method such as quantitative, qualitative, or mixed methods. In other words, research is the generation of new information which nurses and allied health professionals use to formulate evidence and translate into practice.

Quality improvement is the data driven systematic approach by which individuals work together to improve internal systems, processes, costs, productivity and quality outcomes within an organization. An example of a quality improvement model is the plan, do, check, act or PDCA process.

EBP provides transplant nurses and allied health professionals with the most current and best evidence to practice. There are challenges to incorporating EBP into the infrastructure of transplant programs. Education, time, and administrative support are a few. It is imperative that transplant programs support individuals to utilize EBP and research in his or her practice. Ultimately, practicing best practice will empower nurses and allied health professionals to provide quality care leading to best patient outcomes. Several institutions have held workshops or seminars teaching nurses and allied health professionals skills they need for integrating EBP and research into their clinical practice. Organizations such as the International Transplant Nurses Society and the ISHLT have held special sessions on conducting research or translating research into practice during their annual meetings. Time is by far the most challenging barrier. Transplant professionals must carve time to participate in activities promoting the education and implementation of EBP.

The future of transplant nursing and allied health professionals is placed on the individual and the infrastructure of the transplant program. While current barriers exist, professionals must take the initiative to learn the process of EBP and participate in research. Transplant nurses must talk with administrators concerning time to examine best practice, and review existing evidence guidelines. Further research is needed to examine the needs of transplant professionals to facilitate EBP and research into clinical practice. Educators must assure EBP and research concepts are introduced at the undergraduate level. This provides transplant nursing and allied health professionals with great opportunities to examine specific perceptions, knowledge, and barriers within the field of transplantation. Most importantly, transplant nurses and allied health professionals must publish EBP nursing care for patients who are waiting for transplant or have undergone transplantation. Indeed, much education and work is to be done regarding EBP and research in the field of transplant nursing and allied health. This challenge is a great way to start off the New Year. ■

Excerpts from this piece have been published in White-Williams, C. Evidence Based Practice and Research: The Challenge of Transplant Nursing. Progress in Transplantation, Vol 21, No 4 December 2011.

Conflict of Interest Statement: The author has no conflicts of interest to disclose.