Melnyk_Evidence-Based Practice in Nursing & Healthcare, 5e

360 Unit 3 / Steps 4 and 5: Moving From Evidence to Sustainable Practice Change

Sustainment Toolkit. The Fuld ARCC Toolkit is based on the ARCC model and research from multiple sources, including EBP concepts, effective healthcare strategies, outcomes of EBP educational programs, evidence-based change models, leadership and mentoring theories and attributes, and IS. Nomenclature is standardized from the literature to continue to advance the science and conduct high-quality rigorous research as well as bring cultures of EBP to organizations for improving healthcare quality and safety and optimizing patient outcomes (The Fuld Institute, 2021). The Fuld ARCC EBP Toolkit includes each of the key components identi ed in the literature related to effective toolkits. It is evidence-based and individualized to address organizational barriers, and it facilitates the identi cation of key stakeholders and includes structured implementation guides with educational materials and communication plans. Unique characteristics of the Fuld ARCC EBP Toolkit include a progression of ve checkpoints: pre-initiative; building the case: checkpoints 1 and 2; implementation and evaluation; sustainability and intentional reassessment. The checkpoints re ect that EBP initiatives require a signi cant amount of work both before (pre-initiative and building the case) and after actual implementation (sustainability and intentional reassessment). In addition, the toolkit highlights the critical role of not only the EBP initiative’s mentor, but the organizational leader (executive sponsor) as well by including unique responsibilities and actions required of each of them. A single unique attribute worth noting within the Fuld ARCC EBP Toolkit is the portion speci cally designated to facilitate sustainment measures. Notably, if organizations are able to implement change, it is not always sustained due to a lack of infrastructure and consistent reassessment needed to maintain the evidence-based change. The Fuld ARCC EBP Toolkit speci cally identi es structures needed with the Sustainability and intentional reassessment checkpoint to sustain the change (imperative in developing an evidence-based culture). This section identi es key strategies, such as meaningful recognition, internal and external dissemination, accountability measures, and action planning, as necessary components of sustainability. It is imperative that dissemination include ongoing, structured communication to all levels of the organization from the bedside to the boardroom. Action planning should include the strategies used to: hardwire the change into daily work ows and operations; address ongoing education and competency needs; and a cyclical reassessment plan. Developing the sustainment strategies within the implementation progression sets an intentional process to support the evidence-based change and positively impact sustainment measures. Using an evidence-based toolkit is an evidence-based strategy to overcome EBP imple mentation and sustainment barriers and successfully implement practice changes. With each evidence-based practice change, organizations become closer to actualizing evidence-based cultures supporting high-quality patient and organizational outcomes.

The EBP Competencies Another user-friendly resource that can easily be integrated to enhance EBP implementa tion are the EBP competencies. These competencies are a resource that can be used to guide performance expectations related to EBP. Competency re ects the expected and measurable level of performance in nursing, including knowledge, skills, abilities, and judgment based on current science that are required to perform effectively and facilitate high-quality, safe nursing care (American Nurses Association, 2010; Melnyk et al., 2014). In 2014, Melnyk and colleagues conducted a Delphi study and developed a set of competencies speci c to EBP for registered nurses and advanced practice nurses to assist healthcare organizations in ensur ing that clinicians were delivering the highest-quality, safest evidence-based care. This work resulted in 24 EBP competencies—13 for practicing nurses and 11 additional competencies for advanced practice nurses (see Chapter 11). Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.