In our next blog from our series on knowledge mobilisation, Bev Jones @ BevJonesCPD and Claire O’Connor @ClaireOLibrary take us through their experiences of using evidence based practice approaches driven by participation in the Magnet4Europe^© study evaluating the impact of the Magnet Model©.

Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) is one of sixty hospitals, across 5 European countries, participating within the Magnet4Europe© research study.¹ This mixed methods initiative, is testing the feasibility and sustainability of the Magnet Model©² in the European context, examining whether organisational redesign impacts upon clinical work environments. The Magnet© Model consists of 5 components that provide a framework for nursing practice and future research.  In conjunction with our American Magnet4Europe© twinning partners from LeHigh Valley, Pennsylvania, our organisation has used this Magnet© model as a roadmap for change.

Evidence Based Practice (EBP) is widely agreed to be a problem-solving approach to clinical practice, combining evidence with clinical expertise and patient values (Katowa-Mukwato et al, 2020).³   The NHS Constitution⁴ outlines research as part of core business, enabling the NHS to improve the current and future health of the people it serves. Alongside this, the Nursing and Midwifery Council (NMC), sets out a framework for practice in the standards within its code.⁵  One of the four principles of the code is to “practice effectively”, and it describes registrants’ personal responsibility for keeping up to date with the best available evidence and for this evidence to inform their practice.  Using and interpreting EBP is at the core of the NMCs Standards of Proficiency.⁶

Using an EBP approach can aid decision making, as a critical appraisal of the most relevant evidence seeks to provide an answer to a clinical question (Melynk and Finout-Overholt, 2015).⁷   Magnet© designated hospitals require nurses to conscientiously integrate this evidence-based practice into clinical and operational processes, exploring the safest and best practices to improve patient outcomes (ANCC, 2023).²

In addition, strategies to minimise the ‘evidence to practice gap’, known as knowledge mobilisation, utilises any activity which aim to “create and communicate” research-based knowledge within the healthcare setting (Stevenson et al, 2021).⁸  The desire to foster a conscious EBP culture, and nurture a “spirit of inquiry”, was recognised as a beneficial first step change within nursing at GHNHSFT (Melnyk et al 2014).⁷

To facilitate an EBP approach we decided to pilot the ‘Critically Appraised Topics (CATs)’ (Keele University, 2022)¹⁰ framework where evidence is assessed with a view to potentially adopting a change in practice and mobilisation of knowledge throughout the Trust. Stevenson, et al, 2007⁸, suggest that this process allows participants to review the quality of evidence, and translate its meaning into practice, and is a useful approach for those who have limited research experience (Akobeng, 2005).¹²

The first CAT literature review sessions were piloted with the practice development nursing team and wider nursing & midwifery research council members and facilitated by the librarian. The first question related to the best way to facilitate learning in the workplace.   The librarian conducted a literature search to find the best and most appropriate information using a range of searching techniques and resources.  The information was then summarised and presented in a format which made it easier and quicker for the team to read, including several research journal articles.

The second question was posed by a nurse who had read an article from the airline industry about imposing sleep breaks, and wanted to review if this could be applied to nursing.  The third question was based upon a new practice initiative, and stakeholders asked a question during the scoping meeting stage, which was then explored at a CAT session.

These initial sessions sparked considerable discussion around the questions and research articles, and whilst having the designated time and headspace to think about EBP in this way was appreciated, there were no specific outcomes from the session, so the impact was limited. The fourth session on “what are the barriers to nurses’ effective use of early warning systems?” was more successful as there was attendance from staff of different levels and departments, which facilitated good knowledge mobilisation and understanding of the situation in different areas of the Trust. Starting the discussion with analysis of the articles meant that a ‘safe space’ was created before the discussion moved onto service improvement aspects and barriers in the Trust. At the end of the session the participants were asked if there was anything they were planning to do because of the session, and a formal evaluation survey has also been set up to capture both qualitative and quantitative impact in terms of facilitation of knowledge mobilisation, continuing professional development and service improvement. For future sessions we hope to engage additional wards and departments and aim to run sessions on purely ‘clinical’ questions as per the original Keele model¹⁰. We have been asked to run a bespoke session with a team that attended the early warning system CAT, to enable more of their team to attend and contribute. We anticipate that focussing on clinical questions will lead to more concrete impact and change in practice. Future sessions will focus on a more time efficient review of high-quality research papers and reducing the quantity of lower quality material, as initial feedback from the pilot sessions indicated that nurses did not have the time to review more than a few papers.

 Key recommendations

• Run sessions collaboratively with service improvement, practice development teams and library and knowledge services teams
• Keep number of articles to a minimum using good quality research papers
• Advertise sessions widely, encouraging all levels of staff to attend to facilitate good knowledge mobilisation within your organisation
• Evaluate the sessions and capture the impact
• Look towards implementing an evidence-based practice model

References

1. Magnet4Europe: Improving mental health and wellbeing in the health care workplace. 2022. [cited 2022 Jul 25]. Available from: https://www.magnet4europe.eu/
2. American Nurses Credentialing Center (ANCC). Magnet Model. Available from: https://www.nursingworld.org/organizational-programs/magnet/magnet-model/ [Accessed 08/07/22]
3. Katowa-Mukwato, P., Mwwiinga- Kalusopa, V., Chitundu, K., Kanyanta, M., Chanda, D., Mbewe Mwelwa, M., et al. Implementing Evidence Based Practice nursing using the PDSA model: Process, lessons and implications. International Journal of African Nursing Studies. [Internet]. Epub 2021. [cited 2022 Jul 7] 14. Available from: https://doi.org/10.1016/j.ijans.2020.100261
4. Department of Health. The NHS Constitution [Internet]. 2012. [cited 2022 Jul 7]. Available from https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england
5. Nursing and Midwifery Council. NMC Code. [Internet]. 2018. Available from: https://www.nmc.org.uk/standards/code/read-the-code-online/
6. Nursing and Midwifery Council. Standards of proficiency for registered nurses. [Internet]. 2018. https://www.nmc.org.uk/standards/standards-for-nurses/standards-of-proficiency-for-registered-nurses/
7. Melnyk, B. M., Fineout-Overholt, E. Evidence-based practice in nursing and healthcare: A guide to best practice 3rd ed. Philadelphia, PA: Wolters Kluwer. 2015
8. Stevenson, K. Mobilizing physiotherapy knowledge: Understanding the best evidence and barriers to implementation of hydrotherapy for musculoskeletal disease. Physiotherapy theory and practice. [Internet]. Epub 2021 Dec 2 [cited 2022 Jul 7]. Available from https://doi.org/10.1080/09593985.2021.2010847
9. Melnyk BM, Gallagher-Ford L, Long LE, Fineout-Overholt E. The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence Based Nursing. 2014 Feb;11(1):5-15
10. Keele University. Evidence into Practice Groups: Allied Health Professionals. 2022. [Accessed 22/06/22] Available from: https://www.keele.ac.uk/iau/evidenceintopracticegroups/alliedhealthprofessionals/
11. Stevenson, K., Bird, L., Sarigiovannis, P., Dziedzic, K., Foster, N.E, Graham, C. A new multi-disciplinary approach to integrating best evidence into musculoskeletal practice. Journal of Evaluation in Clinical Practice 2007 13:703-708
12. Akobeng AK. Principles of Evidence Based Medicine.  Archives of Disease in Childhood 2005 90: 837-840