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The Value of Evidence-Based Practice in Nephrology Nursing
Suzann VanBuskirk, ANNA President-Elect
More
than any other time since the new millennium, the next few years hold a
unique opportunity for ANNA and nephrology nurses to be recognized as
influential leaders within the nephrology community and the nursing
profession! We find ourselves in the midst of dramatic changes in
reimbursement for renal replacement therapy, anticipating new
conditions of coverage for dialysis and transplantation, and facing the
reality of pay for performance. Many professionals in the nephrology
community are attempting to define ideal patient care while
anticipating economic barriers that will have to be overcome to achieve
it.
The Challenge
As
President-elect of ANNA this past year, I served as the line officer
for the Research Committee. Under the leadership of Terran Mathers,
this committee has been challenged to put ANNA’s Strategic Action,
“research the effects of professional nursing on dialysis patient
outcomes,” into action. This has not been an easy assignment and
their research has led them to find that other nursing specialty
organizations confront similar barriers. How can nurses demonstrate and
document the value they bring to patient outcomes?
The proposed ESRD Conditions of Coverage focus on the results of
patient care, establish performance expectations for facilities, and
eliminate many procedural requirements from the current conditions for
coverage. In addition, they contain several nurse-specific
requirements, including the presence of an RN in the facility at all
times while patients are being dialyzed, an RN designated as the
facility infection or safety officer, and that self-care training must
be conducted by an RN. If these proposed requirements for RN
coverage are challenged by stakeholders who feel the cost of registered
nurses would be too much of a burden, what evidence do we have to
document the value of registered nurses providing care and assuring
outcomes for our patients as compared to other professional or health
care providers, licensed or otherwise? What processes and
structures are in place in the nephrology nurses’ practice settings
that will allow us to discern which interventions are effective and
which are not?
The Age of Accountability and the Rise of Evidence-Based Practice
Government
mandates, consumer demands for accountability, professional efforts to
improve quality, and organizational requirements for fiscally
responsible patient care have given rise to evidence-based practice
(EBP). EBP requires basing decisions concerning what care is provided
and how it is delivered on solid evidence of what works and not on
tradition or unsubstantiated opinions. But, are resources available to
the nephrology nurse to participate in this promising, best-practice
model? And are nephrology nurses ready to meet the challenge? More
importantly how can evidence and research translate into the daily and
routine practice of the nephrology nurse professional?
Barriers that nurses encounter to EBP include:
• Translating the meaning and relevance of the EBP to practice;
• A knowledge deficit when attempting to critique the various types of research studies;
• Being overwhelmed by the variety and evidence uncovered during the evidence-gathering phase; and
• The need for dedicated time in the midst of the current realities or practice and everyday workloads.
Nurses working at the bedside are eager to incorporate evidence into
their practice, but they need help to do it. How can we create
structures and processes to support EBP? What can providers do to
encourage nursing leaders and staff nurses to use or conduct research
to guide their practice? Improved access to computers on nursing
units and in dialysis centers may be a good place to start. Support and
education about the effective use of journal clubs, discussion groups,
role models, and career incentives can increase awareness of sources of
evidence.
The Role of ANNA and Nephrology Nurses
What
can ANNA do to take the lead in developing models and processes to
support EBP? If an organization is to become evidence-based in
its clinical and management practices, then those in leadership
positions must lead the way to support and integrate EBP into the
vision, strategic plan and language of the association. In 1989,
ANNA established a permanent Research Committee and, in 1990, the first
ANNA-sponsored research awards were granted. This coming year,
the timing is right to focus on EBP as ANNA publishes its revised
Standards and Guidelines of Clinical Practice for Nephrology Nursing.
The ANNA Board of Directors has agreed to commit resources to support
and encourage the use of EBP and, as we review and revise our Strategic
Plan during our July Board meeting, we will consider other approaches
to move this forward.
Nephrology nurses must constructively question the care we deliver and
how we deliver it and assure that the care of our patients is grounded
in scientific evidence. A commitment to evidence-based practice will
improve the care of our patients and improve the practice of nephrology
nursing.
Suzann VanBuskirk, BSN, RN, CNN
ANNA President-Elect
Member, Baltimore Chapter
References
Mullem,
C.V., Burke, L. J., Dohmeyer, K., Farrell, M., Harvey, S., John, L.,
Kraley, C., Rowley, F., Sebern, M., Twite, K., Zapp, R., (1999)
Strategic Planning for Research Use in Nursing Practice. Journal of
Nursing Administration, 29(12), 38-42.
Newhouse, R., Dearholt, S., Poe, S., Pugh, L.C., & White, K.M.,
(2004) Evidence-based Practice – A Practical Approach to
Implementation. Journal of Nursing Administration, 35(1), 35-40.
Pravikoff, D.S., Pierce, S., & Tanner, A., (2003) Nursing
Resources: Are Nurses Ready for Evidence-Based Practice? American
Journal of Nursing, 103(5), 95-96.
Stetler, C.B., (2003) Role of the Organization in Translating Research
Into Evidence-based Practice, Outcomes Management, 7(3), 97-103.
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