Partnerships between academia and practice are vital to improving patient care and health system innovations (American Association of Colleges of Nursing [AACN], 2016). Partnerships strengthen the bond between schools of nursing and heath care systems, promoting the planning, implementation, and application of evidence-based practice (EBP) (Broome, Everett, & Wocial, 2014). This article describes the process and outcomes of an academic–practice partnership facilitated by nurse educators in both academic and practice settings. Additionally, the impact of the adoption of EBP projects on clinical practice, students, and practicing nurses is described. Finally, national and international implications for academic–practice partnerships are discussed.
Translation of EBP knowledge to practice is known to be instrumental in improving patient outcomes, including quality and safety; however, it has not yet achieved full adoption as the standard of care (Hagedorn Wonder et al., 2017). Best practices in academic–practice partnerships have demonstrated the significance of its impact on patients, students, direct care nurses, and the medical facility (Tuppal, Reñosa, & Al Harthy, 2017). Translation of evidence-based knowledge in tandem with academic– practice partnerships presents fertile opportunities to transform patient outcomes, empowering nurses to address the complexity of health care systems both nationally and globally (AACN, 2016).
For students, academic–practice partnerships assist them in becoming more competent, conscientious, and compassionate caregivers, promoting them to consider furthering their education in coaching, mentoring, and competency building during the early phases of their employment (Tanriverdi et al., 2017). Nursing faculty involvement benefits the education of nurses in both practice and academic settings, integrating new knowledge between academia and practice (AACN, 2016). Practicing nurses benefit from academic–practice partnerships by learning to identify patient problems, building skills in EBP, and setting the stage for health systems to transform health care (Curtis, Fry, Shaban, & Considine, 2016). Academic–practice partnerships can help to reduce the barriers of translation of EBP to practice (Broome et al., 2014). Overall, health care facilities can benefit from academic–practice partnerships through improved patient outcomes, workforce knowledge of EBP, growth of research and EBP programs, integration of research and EBP into population health initiatives, and advocacy agendas for nursing leadership (AACN, 2016).
Academic–Practice Partnership Structure and Process
Inspired by the Carnegie Report (Benner, Sutphen, Leonard, & Day, 2009) on transforming nursing education, a partnership was formed between a National League for Nursing–designated Center of Excellence in Nursing Education, Indiana University School of Nursing (IUSON), and Indiana University Health (IUH) Academic Health Center, made up of 3 Magnet®-designated hospitals. The academic–practice partnership was designed to bring resources together into a synergistic environment for students, nurses, and nurse leaders, creating the Indiana University Nurse Learning Partnership (IUNLP) model for healthy work environments. The academic–practice partnership provides a foundational structure to help nurses achieve educational and career advancement, prepare students for future to practice, provide mechanisms for lifelong learning, and provide a structure for nurse residency programs.
The partnership structure brings about new and innovative partnerships through connections and open dialogue between nurses, faculty, and students, resulting in improvements in patient care, based on evidence (Broome et al., 2014). The academic–practice partnership model (Broome et al., 2014) provides a framework for improving health outcomes and educational reforms through (a) exemplary nursing practice, (b) knowledge generation/translation/application, (c) transformative learning experiences, (d) transformational leadership, and (e) resources. As part of this partnership structure, faculty representatives were placed in the three Magnet hospitals to assist with partnership projects. In this case, the nurse educator and faculty representative worked within the hospital EBP committee (Hospital Innovative Practice Committee [HIPC]) to reach out to the IUSON undergraduate research class and to assist in nurse-led EBP project proposals.
For several years, practicing nurses at the IUH system satellite hospital's HIPC identified a need to address patient problems and brought them to the IUSON baccalaureate nursing research classroom through a formal partnership between the health care system and the school of nursing. Nurses sought opportunities for students to use the EBP process by identifying problems for proposals to make changes in practice, based on evidence. The EBP proposals were developed using the Rosswurm and Larrabee model (1999) whereby students (a) assessed the need for a change in practice, (b) linked the problem interventions and outcomes, (c) synthesized best evidence, then (d) designed a practice change. The final two steps of the model were not formally addressed by the health care facility: (e) implement and evaluate the practice change, and (f) integrate and maintain practice change, although future faculty and health care facilities plan to undergo these processes in the future. The first four steps (a, b, c, and d) were used for all EBP projects. For those EBP projects with important findings, and which were approved by the HIPC, step five (e) was addressed. This study is being reported at the conclusion of step five (e). Step six (f) remains to be determined as future faculty and health care facilities consider undergoing the integration and maintenance of applicable EBP projects.
The students presented the EBP project proposals to the nurses and classmates, and the hospital liaison nurse educator brought the proposals back to the HIPC for consideration for adoption. The proposals were reviewed by the HIPC for evidence, feasibility, and adoption in the hospital and then, if approved, were implemented using the hospital nursing staff governing committees. Roles were assigned by the nurse educator liaison to the HIPC committee members to assess, analyze, approve, plan, and implement the EBP projects. Institutional review board approval was not needed, as it was considered to be “exempt status” for the project.
Clinical Practice Outcomes
The following are brief descriptions of the clinical practice outcomes from the EBP projects that were adopted and implemented as a result of the academic–practice partnership between IUSON and IUH system satellite hospital.
Code Blue Family Presence
The first EBP project addressed family presence during a code blue (patient resuscitation) situation. This issue was heavily discussed among caregivers throughout the IUH satellite hospital, due to the experience of nurses receiving both positive and negative feedback from families about the presence of family members when their loved one was resuscitated. Some adult unit caregivers encouraged family presence, whereas other caregivers discouraged it. The students' literature review and synthesis supported the notion that family presence during code blue situations can help to decrease the emotional pain of grieving, because family members felt as if they supported their loved one through the death experience (De Stefano et al., 2016; Feagan & Fisher, 2011; Zavotsky et al., 2014). With the support of this evidence, the hospital has adopted this EBP project throughout the facility.
Accurate Blood Pressure Monitoring
The second EBP project proposal addressed the most accurate way to take a manual blood pressure. This topic was particularly important to the direct care nurses because as patient populations are facing more chronic illness than ever, more accurate blood pressures are key to the delivery of safe, quality care. Students found evidence regarding accurate arm circumference measurements, in addition to checking electronic blood pressures with manual sphygmomanometers, which improved the accuracy of the caregivers' readings (Critical Care Nurse, 2017; Tendl et al., 2013). The IUH satellite hospital's HIPC created a “What Every Caregiver Should Know” flyer (Figures 1–2) to be distributed throughout the hospital to educate caregivers about the evidence related to the accuracy of taking blood pressures.
First page of a flyer to educate caregivers about the evidence for taking accurate blood pressure (B/P).
Second page of a flyer to educate caregivers about the evidence for taking accurate blood pressure. (Note. ED = emergency department; Med Surg ICU = medical–surgical intensive care unit.)
Restriction of Oral Intake During Labor and Delivery
Another concern for the nurses was the restriction of oral intake during patients' labor and delivery process. Many labor and delivery units keep their patient nil per os (NPO; nothing by mouth) while in labor due to the risk of aspiration in case an emergent cesarean section is required. Given the length of time patients may potentially be in labor, the nurses wanted to know whether there were best practices for allowing patients with potentially uncomplicated deliveries to have clear liquids during labor. Students presented a protocol change based on evidence that was adopted by the hospital unit and physicians, allowing patients clear liquids during labor (American Society of Anesthesiologists Committee, 2011; Ciardulli, Saccone, Anastasio, & Berghella, 2017). If the patient was believed to need a cesarean section, the nursing staff would stop all clear liquids to the patient. Steps 5 and 6 of the Rosswurm and Larrabee (1999) EBP model are in process, regarding whether patients remained safe without aspirations after the practice change. A testimonial by a labor and delivery staff nurse resulted in the following comment:
Patients who received oral intake during labor have been so thrilled. We have many patients who had babies with us previously, and they were NPO. They said being able to have clear liquids during labor made [the process] so much more enjoyable!
Infant Blood Glucose Protocols
Recommendations for infant blood glucose protocols have changed multiple times over the past decade (Rozance & Hay, 2016), with many health care providers setting various blood glucose limits and treatment protocols. A protocol was established at the IUH satellite hospital many years ago based on the recommendations by the American Academy of Pediatrics (Kelly, 2011). With newer studies and potential protocols available, the nursing team wanted to implement the most current evidence-based practices in blood glucose management for infants. The students presented a protocol change based on evidence (Rozance & Hay, 2016; Thornton et al., 2015; Wight, Marinelli, & Academy of Breastfeeding Medicine, 2014) that was adopted by the unit and physicians. The IUH satellite hospital's HIPC created a flyer with a glucose protocol table for the nurses to use when managing postnatal glucose homeostasis.
Outcomes for Practicing Nurses
Several barriers to the adoption of EBP by nurses continue to present challenges, including database searching skills, lack of time, how to implement EBP in practice, and limited authority to change practice. Some of the barriers include lack of competence (knowledge, skills, experience, confidence) in EBP. Faculty are in a unique position to influence nurse EBP competencies (Melnyk, Gallagher-Ford, Long, & Fineout-Overholt, 2014). Nurses' exposure to nursing students who completed EBP projects in this academic–practice partnership have motivated nurses to develop and sustain EBP programs in their health care facility. This collaboration has inspired many nurses to want to learn more about research and literature reviews so they can perform them in the future. As a result, the IUH satellite hospital has developed a role for EBP mentors to guide bedside nurses with their literature reviews skills (M. Gainey, personal communication, August 1, 2017).
Coordinated by clinical and academic nurse educators, the nurses at the IUH satellite hospital attended the students' EBP project proposal presentations. The bedside nurses were impressed with the breadth and scope of the project proposals, revealing that the students answered the nurses' questions and addressed the planning, implementation, evaluation, and costs associated with their sustainability. One nurse commented on the EBP project proposal presentations:
Students did an amazing job with the [EBP] presentations. I wish this collaboration was available when I was a student. I would have been more engaged in the class if I had known I was working on real nursing issues and able to help change nursing care.
Outcomes for Students
One of the goals of the EBP project exercise with the academic–practice partnership was to assist the students in considering the importance of EBP, both before and after graduation from the school of nursing. The EBP projects required students to analyze real and current health care problems and to propose changes in practice based on evidence. Projects allowed students to understand the application and necessity of implementing EBP in everyday care. One student summarized her experience working on the EBP project: “The [EBP project] was very productive for really diving into research and understanding the application of the concepts.” Another student stated, “I enjoyed how [the course] applied the content to real life or work.” Although it is important to teach EBP knowledge, skills, and attitudes, it is vital to inspire and motivate students to adopt EBP into their lifelong careers. By allowing students to create EBP projects based on real-world problems, the process may inspire nursing graduates to propose evidence-based solutions for future clinical problems, based on evidence.
Students were evaluated on their EBP projects using a rubric that was based on the Rosswurm's and Larrabee's (1999) EBP model. Knowledge and skills from established EBP competencies (Melnyk et al., 2014) for EBP were measured in the EBP projects using the rubric. Knowledge was assessed through the scope of literature review and synthesis of the problem, and skills were assessed through the EBP plan for implementation and evaluation. In addition, focus groups were convened as part of an anonymous university peer review process to determine formative feedback during the semester. Students indicated that they were interested in choosing the topic of the EBP projects, which was facilitated when the hospital nurse educator liaison brought the topics to the class. Many possible topics of patient problems, needs, and gaps were identified and brought to the classroom; therefore, students were able to make their own choices of topics that were of interest to them.
Students, nursing staff, and university faculty created a poster about the adoption of the EBP projects in clinical practice. The students were asked whether they would like to submit their EBP projects for a statewide hospital research conference. Development of scholarly skills occurred with all students, who were mentored by the faculty member and the hospital nurse educator liaison. One student volunteered as a representative of her EBP project group and worked closely with the faculty member and hospital nurse educator liaison. This student collaborated with the faculty and hospital nurse educator liaison, ultimately presenting a poster together at a statewide hospital system nursing research conference (Figure 3). This EBP project provided an opportunity for nurse educators in academia and practice, practicing nurses, and nursing students to work together in the translation of EBP to clinical practice within the academic-practice partnership framework (Broome et al., 2014).
Poster presented at a statewide nursing research conference. Reprinted with permission from Phillips, Gainey, and McAllister.
Strengths of Academic–Practice Partnerships
This academic–practice partnership set the stage for a lasting partnership between academia and heath care. It was founded on principles of the Broome et al. (2014) academic–practice partnership model, which can be accomplished through open dialogue between nurses, faculty, and students to accomplish improvements in patient care. The Rosswurm and Larrabee (1999) EBP model can be used as an EBP framework that is practical for both students and nurses in terms of planning, implementing, and evaluating the outcomes. Strengths of this academic–practice partnership included benefits for students, nurses, faculty and patients. Students learned the value of EBP in relation to real-world problems. Nurses were assisted in the literature search in obtaining evidence for practice changes that they had originally identified. The scholarship of students was facilitated by the faculty and nurse liaison for dissemination in a statewide nursing research conference. A major limitation identified was that the health care facility did not formally measure the patient outcomes of the EBP projects. Future directions include planning structured evaluation of patient outcomes and process indictors before the EBP projects are adopted, addressing the need to plan for the final two steps of the Rosswurm and Larrabee (1999) EBP model (implement and evaluate practice change, and integrate and maintain practice change).
National and International Implications
The implications for academic–practice partnerships are broad in scope, especially when considering national and global health initiatives to meet the critical need of cultural awareness for health care providers, and patient access to and delivery of quality systems of health care (Riner, 2018). There has never been a better time for nurse educators in both academia and practice to join forces, both nationally and internationally, as the world becomes more connected. The academic–practice partnership described in this article exhibits a microcosm of evidence-based changes that took place to improve patient outcomes. The model (Broome et al., 2014) can be used as a framework for nurse educators in academia and practice to enhance national and international partnerships in addressing strategies for enhancing EBP for improved health care worldwide.
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