It Takes a “Village”

BEST patient care results from using the best evidence in practice using your clinical judgment and the preferences and values of patients & families. In shorthand this is called evidence-based practice (EBP).

Most of the time it takes more than one person to bring evidence into practice.   Maybe not really a whole village,….but definitely anyone  who will be affected by the change OR whose cooperation you need to make the change!

team

In the last blog, we considered how to identify a problem clearly by using the acronym PICO.   Here was our example:

  • P = Postoperative patients with ileus (Patient population & Problem)
  • I = Gum chewing postop (Intervention to try out)
  • C = NPO with gradual diet progression when bowel sounds start returning (Comparison intervention—maybe the current protocol or highly varied individual RN expertise)
  • O = Reduce time of postop ileus with sooner return to nutritious eating (Outcome—what you want to happen!)  (For more on PICO check out last week’s post: “You Got a Problem with That? Try PICO)

The next BIG question: “Is the problem you have identified a PRIORITY?”

priority

  • Some priorities are triggered by problems—for example, your observation that something is not working, or poor PI outcome data, or below benchmark HCAHPS scores.
  • Others are triggered by new knowledge—for example, you read an   article, new research has come out, or your professional organization has new standards.

Now what? You need to gather your “village,” even if it’s only 2 people!!   Let’s say postoperative ileus is a BIG, PRIORITY problem on your unit, and you saw a research article on how gum chewing reduces time of postop ileus. Your next question is, “Who do I need to help reduce ileus by trying out gum chewing?” Well…your manager would certainly want to know, and the surgeon. Other patient-care RNs on the unit are critical to its success, too. And maybe you could use some help in finding and critiquing articles/evidence.

team

NO need to go it alone in solving the issue! Find others who care about the problem. Invite them & anyone (stakeholders) who would need to know about the postop gum chewing. The team can be 2 people if you like; or a lot more.

  • If you have a unit-based council, then you already have a pre-made team!
  • If you need to find some teammates, consider some of these people: a respected clinician with lots of respect; a new graduate with lots of energy; someone who loves to read research; & others.

Critical Thinking: Think of a clinical problem on your unit. Write it out in PICO format and list the names of those who would be on your problem-solving “village” team.  Whose cooperation do you need?

Want to read more? Melnyk, B.M., Fineout-Overholt, E., Stillwell, S.B., Williamson, & K. (2009). Evidence-Based Practice: Step by Step: Igniting a Spirit of Inquiry, American Journal of Nursing, 109(11), 49-52, doi: 10.1097/01.NAJ.0000363354.53883.58

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