This Fellowship plan began with a vision by nursing administrative leadership. The question posed to the Council of Application of Research and Evidence (CARE) was: “What are the most effective methods to conduct an ideal EBP program in order to address the learning needs of bedside nurses in order to improve patient outcomes?” The final outline of the Fellowship was determined from published literature and from practices at other hospitals and academic centers [7
]. It was tailored to meet the needs of this hospital’s nurses. Brainstorming, a draft proposal, and subsequent revisions as a Council were developed as a result of this challenge from nursing leadership.
The purpose of the nursing Fellowship program was to promote quality care for the patients by providing the knowledge, skills and attitudes to bedside nurses for implementation of EBP. This purpose was accomplished by the incorporation of research into practice, which will close the time delay now seen nationwide between knowledge generation and its implementation.
The reality of healthcare practice includes the need for funding. Funding was needed for a research and statistical consultant, the salary of 92 work hours per Fellow, supplies, and the costs of poster generation and conference attendance for subsequent presentations. Disseminating the results of the EBP was critical to the program’s goal. The hospital sought and obtained funding from a local community foundation and a local benefactor. Similar support from the hospital included technological, logistic, and coordinator support for the duration of the program. In addition, continuing education credits that count toward re-licensure were provided for the Fellows through the hospital.
A foundational consideration was the choice of a model used for the program. The process by which research is initially identified, transferred throughout the nursing staff, and used in patient care follows a nursing practice framework. Multiple clinical and academic settings use the Iowa Model [7
], which uses an algorhythm that nurses ‘find intuitively understandable” [10
]. The well-established Iowa model and educational program were used as a template for the Fellowship after evaluating multiple other models [9
The modifications of the original educational program with a more research-focus are listed below [11
]. These modifications were made in keeping with cost accountability and timeline considerations:
• timeline reduced from one-to-two years to three months;
• reduced class meetings from 12 to 4 days;
• placed locating evidence on first day, rather than third;
• removed conference attendance as part of initial Fellowship timeline;
• added discussions each meeting to foster collaboration and problem-solving as a group; and
• included creation and presentation of poster and oral presentation to leaders and mentors as part of the Fellowship timeline.
Once the plan was complete and funding obtained, the application and review process were developed by the CARE council. The application form included suggested topics for an EBP project, but choosing one of the suggested topics was not used as a criterion for selection. The application process was announced via the hospitals newsletter, emails and nursing forums and was available on-line and in paper formats in various locations. Each applicant submitted an interest statement, an outline of previous professional changes he/she had implemented and their outcomes, as well as an EBP project idea. Completed applications were blinded and forward to the CARE council members by the chair for review and scoring. Applicants were then notified via letter of results and comments. Those applicants that were not selected were given feedback on methods to improve their application for the next submission.
Each chosen Fellow obtained a letter of support from his/her leader and signed a contract to ensure clear communication of expectations. Each Fellow agreed to attend and participate at all EBP workshop sessions. In addition, they agreed to meet individually with their identified mentor and nurse leader at least one hour per month. Furthermore, they agreed to complete the EBP project in the three months of the Fellowship and promote the further implementation of their EBP across departments and committees in subsequent months. Finally, the Fellows agreed to develop and deliver a poster and podium presentation and submit their work for a regional or national conference.
The five selected Fellows were mentored for 92 hours over three months. The Fellow was provided with 32 hours of workshop time and used the remaining 60 hours toward mentored implementation and evaluation of the new practice. The Fellowship hours were separate from his/her usual practice responsibilities on the department schedule and did not count toward the departmental productivity goals.
It was determined that the Fellowship was best presented in a workshop format with an application focus with each topic. The consideration of the program as a workshop was critical to its success for bedside nurses. Each presentation, whether on searching literature, evaluating literature, or entering excel data was followed by a mentored practice session on computers with Internet access.
Our topics were modified for bedside nurses. The following were topics covered during the workshops:
• Organizational and leadership support of EBP
• The Iowa Model
• Defining the EBP project’s development with PICOT (population, intervention, control or comparison group, outcome, and timing)
• Action plan
• Feasibility analysis and team building
• Literature and web resource searching
• Evaluating resources for quality
• Obtain evidence (baseline data)
• Excel data entry
• Role of statistics
• Writing a protocol/procedure/guideline
• Implementing change
• Poster and podium presentation development
The consideration for application to practice at all times was the rationale for reducing sections on literature reviews and literature synthesis. For example, there was no use of research critique forms. This Fellowship did not include some models such as the research translation model, nor did it include research language such as independent and dependent variables. The focus of the research parts of this Fellowship focused on the use of high-quality evidence, such as from internationally recognized sources. The purpose of the statistical presentation was to enhance understanding of statistics without explaining how to conduct the analyses.
Our modifications also included the use of notebooks to track progress, ideas, and barriers for problem solving by the individual with the mentor or with the Fellowship group. Each workshop concluded with a review of assignments that were to be completed prior to the next meeting.
To ensure that the process was understandable, the planner and major presenter continually linked the EBP process to the nursing process of assesses, diagnose, plan, intervene and evaluate, which was labeled the ‘Iowa Model in a nutshell’:
• Identify an issue of concern; and
• Assemble and evaluate evidence in literature and current best practices Assess
• Measure baseline data and determine exact issue that can be addressed Diagnose
• Develop implementation and outcome measurement steps Plan
• Pilot protocol Implement
• Measure process and outcomes Evaluate
The goals of this Fellowship were accomplished in three months with meetings held approximately every three weeks. The remaining time was spent on individual mentored development of the project. A recognition event was held at the end of the three months with mentors and leaders. At that time, Fellows presented their posters and a podium presentation to the leadership, followed by several weeks of presentations to various audiences, including the funders, the hospital staff and medical staff.