FACILITATING EVIDENCE-BASED PRACTICE IN A CHRONIC CARE SETTING

Abstract

The current health care environment, with its dual emphasis on quality care and cost containment, has created an urgency for health care practitioners to have timely access to the best evidence to support decision-making in their areas ofpractice, whether in policy development or in direct service delivery. The purposes ofthis project were to take a broad look at the issues surrounding the facilitation of evidence-based practice, to focus on the specific issues related to evidence-based practice in a chronic care setting, and to demonstrate one method of bringing evidence to practice in the form of an educational intervention. A review ofthe literature related to research utilization and evidence-based practice revealed barriers and facilitators ofboth processes in a variety ofhealth care settings. Numerous models to guide the implementation ofthese processes were described in the literature. However, none ofthe literature accessed in the review focused specifically on implementing evidence-based practice in a chronic care setting. Key considerations in implementing evidence-based practice were identified as (1) access to relevant evidence from the literature; (2) resources available in the practice environment; (3) expertise of the practitioners; and (4) patients’ preferences. A review ofselected literature related to adult education was carried out to ensure that the planned educational intervention not only had content that was evidence-based, but also integrated the principles of adult education into its methodologies. Concepts related to learning styles, critical thinking, and motivation of adult learners were key to the design ofthe intervention. Management support, available resources, front line staff and the work environment were considerations in planning and piloting the staff education. The Iowa Model for research utilization was chosen to guide the process ofbringing evidence to practice to address the clinical question ofhow to prevent dehydration in the frail elderly population. The model provided a systematic approach to defining the clinical question, accessing and critiquing the relevant literature, deciding on sufficiency ofthe evidence, and developing and piloting interventions. Evaluation ofthe pilot project, and implementation iii throughout the rest ofthe facility are included in the plans for the future. This project has relevance for clinical leaders and educators in chronic care in that it explores some ofthe barriers and facilitators of evidence-based practice in that setting, and provides a concrete example of an educational intervention to promote the integration of evidence into practice. It also identified gaps in the research literature related to care ofthe chronically ill that can point the way for future study in that area.