Similarity no more than 10%

Research Critique – Article choices

Select

 

one of the following research articles for
 Assignment 2:

 

Underhill, M., Roper, K., Siefert, M., Boucher, J., & Berry, D. (2015). Evidence-based practice beliefs and implementation before and after an initiative to promote evidence-based nursing in an ambulatory oncology setting. Worldviews on Evidence-Based Nursing, 12(2), 70-78.

Irwin, M., Bergman R., & Richards, R. (2013). The experience of implementing evidence-based practice change: A qualitative analysis. Clinical Journal of Oncology Nursing, 17(5), 544-549.

 

Assignment 2: Research Critique (12 points)

Assignment Instructions:

For this assignment, students will critique either a quantitative or a qualitative research article. Select one of the articles posted in Week 4 Module.

Assignment Criteria:

1. Select a research article provided in the Week 4 Module.

2. Copy and paste the appropriate research critique grid found in Week 4 into a new Word document.

3. Complete each section of the research critique grid. The “Analysis” section of the research critique grid should be specific. Use bullet points for this section and support each yes/no analysis with comments.

4. Critique the article and include the strengths and weaknesses.

5. The research critique grid should be added as an appendix to this paper.

6. The scholarly paper should be in narrative format 2-3 pages, excluding the title, reference and appendix pages.

7. Include an introductory paragraph, purpose statement, body (summary page) and a conclusion.

8. Include level 1 and 2 headings to organize the paper.

9. Write the paper in third person, not first person (meaning do not use ‘we’ or ‘I’) and in a scholarly manner. To clarify: I, we, you, me, our may not be used. In addition, describing yourself as the researcher or the author should not be used.

10. Include the chosen article in the reference page.

11. APA format is required (attention to spelling/grammar, a title page, a reference page, and in-text citations).

12. Submit the assignment to Turnitin prior to the final submission, review the originality report, and make any needed changes.

13. Submit by the posted due date.

Assignment 2: Research Critique: Grading Rubric (12 points)

2 points

1 point

2 points

0 point

1 point

0 point

Assignment Criteria	5 points	3 points			2 points			1 point
All topics addressed and all questions fully answered.	All topics/criteria addressed and most questions fully answered	All topics/criteria addressed and most questions partially answered.	One or more topics not addressed or completely answered.
Quality/Accuracy of Information	4 points	0 points
Information clearly relates to the main topic. It includes several supporting details and/or examples.	Information clearly relates to the main topic. It provides supporting details and/or examples.	Information clearly relates to the main topic. A few details and/or examples are given.	Information has little or nothing to do with the main topic.
Organization	1 point			0 point
Information is very organized with well-constructed paragraphs and levels of heading.	Information organized with well-constructed paragraphs and levels of heading	There is an attempt at organization but errors exist. No levels of heading.	The information or overall structure appears disorganized.
Sources	0.5 point	0.25 points
All references are from relevant peer-reviewed sources, within a 5-year timeframe or are classic sources.	The majority of references from relevant peer-reviewed sources, within a 5-year timeframe or are classic sources.	Some references are from non-peer-reviewed sources or are older than 5 years.	Majority of references are from non-peer-reviewed sources or are older than 5 years or
Earned Points
Up to 10% of the assigned points (total points of assignment) can be deducted from the earned points for errors in APA style [title page, introduction, purpose statement, level heading, conclusion, references, citations, and format], spelling, and/or grammar.
Final Total

appendix

Research Critique Framework: Quantitative Research

Aspect of the Report	Critiquing Questions	Answer Yes/No	Analysis
Title	· Is the title a good one, succinctly suggesting key variables and the study population?
Abstract	· Did the abstract clearly and concisely summarize the main features of the report (problem, methods, results, conclusion)?
Introduction Statement of the Problem	· Was the research problem stated clearly and was it easy to identify? · Is the problem significant for nursing? · Was a quantitative approach appropriate for this research problem?
Hypotheses or Research Questions	· Were research questions and/or hypotheses explicitly stated?
Literature Review	· Was the literature review up-to-date and based mainly on primary sources? · Did the review provide a state-of-the-art synthesis of evidence on the problem? · Did the literature review provide a strong basis for the new study?
Conceptual/Theoretical Framework	· Were key concepts adequately defined conceptually? · Was a conceptual/theoretical framework articulated – and, if so, was it appropriate?
Method Protection of Human Rights	· Were appropriate procedures used to safeguard the rights of study participants? · Was the study externally reviewed by an IRB/ethics review board?
Research Design	· What was the design of the research? · Was the number of data collection points appropriate? · Did the design minimize biases and threats to the internal, construct, and external validity of the study (e.g., was blinding used, was attrition minimized)?
Population and Sample	· Was the population identified? Was the sample described in sufficient detail? · Was the sample size adequate? Was the sample size based on a power analysis?
Data Collection and Measurement	· Were the operational and conceptual definitions congruent? · Were specific instruments adequately described and were they good choices, given the study population and the variables being studied? · Did the report provide evidence that the data collection methods yielded data that were reliable, valid, and responsive?
Procedures	· If there was an intervention, was it adequately described, and was it rigorously developed and implemented? · Were data collected in a manner that minimized bias? Were the staff who collected data appropriately trained?
Results Data Analysis	· Were analyses undertaken to address each research question or test each hypothesis? · Were appropriate statistical methods used given the level of measurement of the variables, number of groups being compared, and assumptions of the tests?
Findings	· Was information about statistical significance presented? · Were the findings adequately summarized, with good use of tables and figures?
Discussion Interpretation of the Findings	· Were all major findings interpreted and discussed within the context of prior research and/or the study’s conceptual framework? · Was the issue of clinical significance discussed? · Were interpretations well-founded and consistent with the study’s limitations? · Did the report address the issue of the generalizability of the findings?
Implications/ Recommendations	· Did the researchers discuss the implication of the study for clinical practice or further research – and were those implications reasonable and completed?
General Issues Presentation	· Was the report well-written, organized, and sufficiently detailed for critical analysis? · Was the report written in a manner that makes the findings accessible to practicing nurses?
Researcher credibility	· Do the researchers’ clinical, substantive, or methodologic qualifications and experience enhance confidence in the findings and their interpretation?
Summary Assessment	· Despite any limitations, do the study findings appear to be valid – do you have confidence in the truth value of the results? · Does the study contribute any meaningful evidence that can be used in nursing practice or that is useful to the nursing discipline?

Note. Adapted from “Guide to an Overall Critique of a Quantitative Research Report,” by D. F. Polit and C. T. Beck, 2017, Nursing Research: Generating and Assessing Evidence for Nursing Practice (10th ed.), pp. 102-105.

544 October 2013 • Volume 17, Number 5 • Clinical Journal of Oncology Nursing

Margaret M. Irwin, PhD, RN, MN, Rosalie M. Bergman, DNP, RN, OCN®, and Rebecca Richards, DNP, RN, NP-B, AOCN®

The Oncology Nursing Society (ONS) and ONS Foundation worked together to develop the
Institute for Evidence-Based Practice Change (IEBPC) program to facilitate the implementation
of evidence-based practice (EBP) change in nursing. This analysis describes the experience of
19 teams of nurses from various healthcare settings who participated in the IEBPC program.
Qualitative analysis of verbatim narratives of activities and observations during the process of
implementing an EBP project was used to identify key themes in the experience. EBP implemen-
tation enabled participants to learn about their own practice and to experience empowerment
through the evidence, and it ignited the spirit of inquiry, team work, and multidisciplinary col-
laboration. Experiences and lessons learned from nurses implementing EBP can be useful to

others in planning EBP implementation.

Margaret M. Irwin, PhD, RN, MN, is a research associate at the Oncology Nursing Society in Pittsburgh, PA; Rosalie M. Bergman, DNP, RN, OCN®, is an associate
scientific director and medical science liaison at Novartis Pharmaceuticals in Allison Park, PA; and Rebecca Richards, DNP, RN, NP-B, AOCN®, is an oncology clinical
coordinator at Genentech BioOncology in Edgar, WI. The authors take full responsibility for the content of the article. The authors did not receive honoraria for
this work. The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.
No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or editorial staff. The
views expressed in this article are those of the authors and do not reflect the official policy or position of the Oncology Nursing Society. Irwin can be reached at
mirwin@ons.org, with copy to editor at CJONEditor@ons.org. (Submitted February 2013. Revision submitted March 2013. Accepted for publication April 14, 2013.)

Digital Object Identifier:10.1188/13.CJON.544-549

The Experience of Implementing Evidence-Based
Practice Change: A Qualitative Analysis

E
vidence-based practice (EBP) is regarded by profes-
sionals as the basis for nursing practice ( Jutel, 2008;
Newhouse, Dearholt, Poe, Pugh, & White, 2007).
However, gaps and delays in translating evidence
into clinical practice are well recognized (Dudley-

Brown, 2012; White, 2012), and understanding that those
gaps are more about factors that influence the process of EBP
implementation than about individual skills for evidence ap-
praisal is important (Fineout-Overholt, Melnyk, & Schultz,
2005; Gale & Schaffer, 2009). Development of effective strate-
gies to implement evidence in nursing practice is a dedicated
area of exploration (Doorenbos et al., 2008). A need exists to
describe and understand the experience of implementing EBP
in nursing and to determine more effective facilitation strate-
gies (Friedman et al., 2009).

The Institute for Evidence-Based Practice Change (IEBPC)
was developed by the Oncology Nursing Society (ONS) and ONS
Foundation to facilitate implementation of EBP in nursing. Teams
of nurses were educated in EBP implementation and, as part of
program activities and evaluation, IEBPC participants recorded
reflective narratives of their experiences. The purpose of this
article is to describe the experience of implementing an EBP
change through analysis of verbatim narratives. Learning from
the experience of others can help other nurses implement EBP.

Methods
The sample consisted of verbatim reflection log entries from 19

teams who participated in the IEBPC in 2009 and 2010. The IEBPC
program included a 2.5-day conference involving lectures and
group work that provided content for the EBP process, litera-
ture searching, and development of an implementation plan,
project management, and outcomes measurement. Participant
teams consisted of a champion (an advanced practice nurse to
lead and advocate for the project), a sponsor (an individual with
administrative authority), and a target (staff nurse whose prac-
tice was the target of change). Breakout sessions were used to

© George Doyle/Stockbyte/Thinkstock

n Article

FIGURE 1. Questions for Reflection

• How will you use what you have learned to continue to improve and
move things forward (if relevant)?

• What have you and your project team learned this month?
• What major actions in your project did your team take this month?
• What responses did you see to these actions?
• As you reflect upon this past month, what things strike you,

surprised you, frustrated you, or delighted you?

© Oncology Nursing Society. Unauthorized reproduction, in part or in whole, is strictly prohibited. For permission to photocopy, post online, reprint, adapt,

or otherwise reuse any or all content from this article, e-mail pubpermissions@ons.org. To purchase high-quality reprints, e-mail reprints@ons.org.

Clinical Journal of Oncology Nursing • Volume 17, Number 5 • Implementing Evidence-Based Practice Change 545

develop initial implementation plans, facilitate group discussion
on change strategies, and identify appropriate outcome mea-
sures for each team. The IEBPC mentor group assigned a mentor
to participating teams. Mentors were advanced practice nurses
who had successfully implemented EBP in nursing practice set-
tings, and they provided individualized, unstructured mentoring
for 12 months following the conference via e-mail communica-
tion and phone conferences.

As part of the program’s activities for reflective learning and
program evaluation, the champion from each team was asked
to consider and respond to a series of questions about the ex-
periences of the team (see Figure 1). Reflections were posted
on a secure virtual office Web site, creating a written verbatim
record for analysis. Participants were informed that log entries
were voluntary; that information would be used by ONS for
analysis, program evaluation, and planning; and that individu-
als and organizations involved would not be identified in any
publication of resulting information.

Verbatim postings were downloaded from the site and de-
identified to maintain confidentiality. All entries were inde-
pendently reviewed by two authors using content analysis to
identify themes and concepts. An audit trail was maintained by
documenting all analysis on verbatim documents. After inde-
pendent review, the authors compared, organized, and merged
themes and concepts until consensus was reached.

Results
Sample Characteristics

The sample consisted of 140 verbatim log entries from 19
IEBPC teams. Eight teams practiced in a comprehensive cancer
center, eight in a community hospital, two in an outpatient
setting, and one in industry nursing. The number of log entries
for each team ranged from 2–13, with a mean of 7.6 per team
during a 12-month period. Three entries total were completed
by a target nurse; all others were done by team champions.
One of the 19 teams withdrew from the program after two
months. Participants worked in a variety of practice settings
and worked on different aspects of clinical practice. Areas of
practice addressed by teams in the EBP projects are shown
in Figure 2.

Themes

Analysis demonstrated the following major themes: key
implementation actions, critical success factors, difficulties and
frustrations, and the process of discovery.

Key implementation actions: Key actions identified by teams in-
cluded education, marketing, use of recognition and incentives,
development of tools for implementation, and obtaining institu-
tional review board (IRB) approval. Corresponding exemplars
are shown in Figure 3.

Educational activities included staff education about the
project and related evidence, and how to administer assessment
tools. Teams also were involved in educating other disciplines
or nursing units about the project and presenting to nursing

FIGURE 2. Areas of Nursing Practice Change

• Cancer-related fatigue interventions
• Chemotherapy administration guidelines implementation
• Depression screening and referral
• Interventions for falls prevention
• Management of chemotherapy-induced nausea and vomiting
• Multidisciplinary walking discharge planning rounds
• Oral care protocol for prevention of oral mucositis
• Patient adherence to oral chemotherapy
• Patient mobility improvement in the inpatient setting
• Patient self-care for management of chemotherapy side effects
• Patient sexual health
• Prevention of central line-associated bloodstream infection
• Skin care management during radiation therapy
• Ventilator -associated pneumonia care bundle

Educational Activities

“We will also have to educate the staff, MDs, and techs and RNs
about the project to ensure compliance.”

“[We] developed an education poster.”
“We are educating others about EBP at every opportunity.”
“We posted our first educational blog in our online publication for

nurses/clinical staff.”

Marketing

“[We are] showcasing the project to administrative leadership.”
“We are translating the concept of EBP to other nurses as well as

nonnursing personnel (i.e., pharmacy and the medical staff) so
there is common understanding and sharing goals/mission/vision.”

Recognition and Incentives

“[We are] finding special ways to thank EBP team members for
their contributions.”

“We actually came up with an incentive program today to assist
us in getting surveys completed.”

“This month, we have celebrated some success.”

Development of Tools for Implementation

“[We] developed . . . call scripts incorporating EBP related to side-
effect management as available.”

“[We] developed sample documentation templates.”
“[We] developed EBP call flow chart schema.”
“Development of all-inclusive line care stamp”
“The placement of a visual clue of the HOB [head of bed] at 30

degrees on all the ICU [intensive care unit] walls”

Obtaining Institutional Review Board (IRB) Approval

“We keep our fingers crossed, as the Scientific Review Committee
and the IRB are the next hurdles.”

“Institution support seems to be there in the form of an RN who is
also a PhD and sits on the IRB—great for us.”

“We hadn’t anticipated . . . that we would need to write a protocol
and get IRB approval. This is going to be a major task and our
biggest hurdle. It’s frustrating, as we would like to begin, and it
seems we get bogged down in red tape.”

FIGURE 3. Key Evidence-Based Practice (EBP) Project
Implementation Strategies

546 October 2013 • Volume 17, Number 5 • Clinical Journal of Oncology Nursing

practice councils and medical staff committees. Marketing ef-
forts were used to gain support and to facilitate involvement
and collaboration with others.

Several teams incorporated recognition and the use of incen-
tives into project implementation. These strategies aimed to get
staff attention and encourage participation in project activities
and related changes to patient care.

Teams developed a variety of tools to implement practice
change (i.e., assessment forms, decision-making algorithms,
documentation templates, communication scripts, signage, care
checklists). Almost all of the teams used visual tools, which in-
cluded a mark on the wall that enabled the nurse to see quickly if
the head of the bed was sufficiently elevated, as part of a project

to address ventilator-associated pneumonia. One team working
to increase patient ambulation obtained a variety of posters from
international cities to place on the walls in the hallway so they
could encourage patients to “walk to Paris.” One team noted,
“The visual cues have helped with our compliance.”

Five teams were required to obtain IRB approval from their
organizations before they could begin work on EBP projects. Two
of those involved full review, and the others met expedited or
exempt review criteria. Some teams expressed frustration with
delays associated with getting IRB approval and viewed the pro-
cess as a barrier, and others identified the process as part of imple-
mentation. Teams that did not express frustration in obtaining IRB
approval had assistance from nurse researchers. One team noted,
“Institutional support seems to be there in the form of an RN who
is also a PhD and sits on the IRB—great for us.” Teams that required
IRB approval described delays that ranged from 3–6 months.

Critical success factors: Critical success factors were seen to facil-
itate implementation of the practice change when present and,
if absent, were considered barriers to change. Critical success
factors expressed in reflective narratives included time, organi-
zational support, engagement and teamwork, communication,
planning, and maintaining focus (see Figure 4).

Time was the critical success factor expressed most fre-
quently. Some teams received an appropriate amount of time
to work on the EBP project, whereas others experienced a lack
of time, which they saw as a barrier.

Support or lack of support was expressed by all teams. Most
experienced support from others such as managers, nursing staff,
and physicians, but some teams experienced areas where sup-
port was lacking. One team initially was unable to get assistance
from the organization’s librarian to obtain evidence, and the
team was told that the service was not available to nurses. That
problem was resolved by the nurse executive. Lack of support
was associated with competing priorities within an organization,
which prevented providing attention to EBP implementation.

Team reflections also identified the importance of support
from mentors in the program. Teams frequently expressed the
importance of teamwork and stakeholder engagement. Team-
work and engagement of physicians, nursing staff, and other dis-
ciplines were associated with progress in EBP implementation.
Conversely, lack of engagement of key groups inhibited progress.

Inadequate communication inhibited progress, and teams
noted that good communication was a critical success factor.
However, time constraints and competing priorities made com-
munication challenging. As one team noted, “We learned that
when our schedule gets busy, our communication among our
team members suffers.”

Teams expressed the importance of planning and identified
helpful plan characteristics. Taking small steps, clarity and sim-
plicity of actions, and setting deadlines were important compo-
nents of planning (see Figure 5). Several teams talked about the
difficulty of maintaining focus on their projects and the frequent
efforts to refocus. Maintaining focus in the work setting was seen
as difficult, and loss of focus was associated with lack of progress.

Difficulties and frustrations: Several difficulties and frustrations
were expressed, including competing priorities, challenges in
data collection and measurement of results, and the impact of
staff turnover (see Figure 6). Competing priorities had an effect
on the amount of time and attention devoted to the EBP project

Time

“We are given the time and resources . . . and spend the time
needed.”

“We continue to feel frustrated with the lack of available time to
meet and work on our project.”

Support

“Nursing administration and our EBP committee have been very
supportive and willing to help in our endeavors.”

“Mentoring support really helped move us forward with confidence
and needed direction.”

“The support from our oncologists has been amazing.”

Teamwork and Engagement

“It is great to rely on each other and know we have a unified
mission/vision.”

“Engaging the staff has brought forth great suggestions and prac-
tice changes.”

“We are behind on our timeline. This is mainly occurring because
staff participation has slacked.”

Communication

“Poor communication within the team is contributing to ineffec-
tiveness.”

“Ongoing communication and sharing project progress is key.”

Planning

“You cannot overplan.”
“Careful planning and involvement of all players is key to a suc-

cessful launch.”

Maintaining Focus

“[We] remind each other to focus. We will conquer the world next
year.”

“My challenge is always trying to keep focused and not get over-
whelmed.”

“The other team members have lost focus with distractions in their
roles. . . . We have had to regroup.”

“The challenge is to keep the focus on our project.”
“When you focus on an issue, you tend to see results!”

FIGURE 4. Critical Success Factors in Evidence-Based
Practice (EBP) Implementation

Clinical Journal of Oncology Nursing • Volume 17, Number 5 • Implementing Evidence-Based Practice Change 547

by team members, and conflicts arose from other organizational
initiatives that fought for staff attention. Variation in patient care
needs also required that work on the EBP project be postponed.

The program requested teams to be involved in data col-
lection and measurement of results to monitor progress. The
majority of participants expressed difficulty because of a lack
of knowledge, barriers in obtaining data, and a lack of time to
collect and analyze data.

Several teams noted the value of data collection and measure-
ment in statements such as, “It is exciting to see the results,”
and, “We are able to see clear improvement in CLABSI [central
line-associated bloodstream infection] rates.” One team noted
that once some results could be observed, those results contrib-
uted to a positive experience. They said, “We are delighted that
we have an end result of our work. We are also excited to begin
the next phase of data collection.”

Team progress was affected by turnover of team members as
well as changes in staffing and management in the organization.
One team expressed the effects of their chief nurse executive
resignation by stating, “I am surprised, when there is an underly-
ing culture of anxiety and of the unknown, how immobilizing it
can be. The uncertainty of survival literally pushes patient care
initiatives and things that are important to the background! . . .
It has been a bit of a black hole as far as support for our project.”

Discovery: Areas of discovery expressed in narratives included
learning about their practices, learning about each other, ignit-
ing the spirit of inquiry, experiencing empowerment through
evidence, and learning about the challenge of sustaining im-
provement. Exemplars in these subthemes are shown in Figure 7.
Participants expressed experiences that were instructive, affirm-
ing, and inspiring in the process of implementing EBP change.

Discussion
This analysis provides a description of the experience of

nurses implementing different EBP change projects in a variety

of settings. Description comes from verbatim narratives of nurses
directly involved in the effort. Implementation activities reflected
common strategies for EBP change (e.g., education, communica-
tion, use of reminders, engagement of stakeholders). Education
was identified as a common activity for knowledge translation,
and use of reminders was identified as a successful strategy in
EBP implementation (Shojania & Grimshaw, 2005; Sudsawad,
2007; Titler, 2008). Nurses who participated in the IEBPC pro-
gram demonstrated creativity in the development and use of
visual tools in implementing new procedures. Many of these
visual tools also functioned as reminders.

Requirements for IRB approval were not consistent across or-
ganizations. Projects of two teams involved direct sampling and
assignment of patients to test interventions. These projects clearly
met recognized definitions of research requiring IRB approval
(Cepero, 2011). Other submissions only involved the application
of known available evidence to change nursing procedures or
policies. IRB processes substantially contributed to delays. Qual-
ity care demands that nurses use EBP, but organizations demand
approval to do so. Most EBP can be viewed as part of normal clini-
cal activity and could be appropriately reviewed by usual clinical
management processes, the same way as policies and procedures
(Melnyk & Fineout-Overholt, 2011). This area causes some contro-
versy, and broad discussion and clarification would be beneficial.

Many of the critical success factors in this article have been
identified by others (e.g., time, support, communication, plan-
ning). Time constraints have been described as significant bar-
riers to EBP in nursing and to sustaining practice improvements
(Chin et al., 2008; Cooke et al., 2004; Edvardsson et al., 2011;
Smith & Donze, 2010; Wolfson et al., 2009). In the current analy-
sis, some participants were given time dedicated only to EBP

Small Steps

“We have learned that all of these small steps bring us closer to our
goal. . . . It feels less overwhelming as we complete each step.”

“By working on this bit by bit, we are getting there.”
“Our motto is, ‘Slow and steady wins the race.’”
“Trying to find ways to break it down and move our project for-

ward (even at a snail’s pace) is the biggest challenge.”

Clear and Simple Actions

“Keep it simple.”
“Our team has identified the need to be a little more proactive regard-

ing establishing the action steps needed to complete the project.”
“We recognize that we need to have a formal rollout plan.”

Establishing Deadlines

“Deadlines are good. . . . Deadlines are good.”
“Deadlines are good. I work better that way.”
“Nurses need to be given specific expectations and deadlines.”

FIGURE 5. Useful Plan Characteristics

Competing Priorities

“The number of ‘have to’ projects continues to grow. . . . I am most
frustrated with getting everything done.”

“The hospital initiated several projects that took resources from
our group.”

“We are competing with many other educational projects at the
moment, so we are hanging back.”

Data Collection and Measurement

“It has proved to be a very slow process as we struggle to under-
stand statistical information.”

“They just don’t teach the finer points of data collection to regular
nurses.”

“It has been a struggle to get the discharge information.”
“We have identified gaps in data available.”
“Data collection is taking more time than we originally

anticipated.”

Staff Turnover

“Our champion has left. . . . We have been floundering, trying to
adjust, so nothing really [was] done this month.”

“The momentum we had gained was lost with . . . the loss of key
staff.”

FIGURE 6. Difficulties and Frustrations Encountered

548 October 2013 • Volume 17, Number 5 • Clinical Journal of Oncology Nursing

projects, but others were not. The issue of time as a necessary
resource for EBP implementation needs to be addressed if nurses
are to achieve the goal of providing evidence-based patient care.

Helpful characteristics for creating a plan (e.g., setting dead-
lines, taking small steps) have not been regularly identified in
studies of EBP, but they are common to quality improvement
(QI) methods and are part of general project management con-
cepts (Terhaar, 2012). Collaboration among QI practitioners,
managers, and clinicians can provide approaches to facilitate
EBP by combining the expertise of these groups.

Findings regarding the value of support and good commu-
nication are in concert with findings of others who have de-
scribed successful strategies for EBP and guideline implementa-

tion (Terhaar, 2012). The nature of critical supports (e.g., time)
points to the role of managers and administrators in facilitating
EBP in nursing. Participant narratives in the current analysis
support the value of mentoring described by others (Fineout-
Overholt & Melnyk, 2011; Mick, 2011).

The need to actively maintain focus and refocus efforts in
EBP implementation has not been previously described. Not
surprisingly, maintaining attention to a specific new initiative
in a setting of competing priorities can be difficult. Purposeful
incorporation of strategies and methods to maintain focus may
facilitate EBP implementation.

The importance of teamwork and collaboration in implement-
ing change and maintaining high-performing organizations has
been described in previous studies (Nelson, Batalden, & God-
frey, 2007; Wolfson et al., 2009). Findings in the current analysis
suggest that the process of implementing an EBP change also
can be a vehicle for team building and collaboration. Participant
comments demonstrated staff and interdisciplinary engagement
in the project, and the process provided opportunities for new
interactions within teams and among stakeholders.

In contrast to challenges, frustrations, and barriers to EBP
typically identified in the process of implementing EBP, experi-
ences here also were uplifting and empowered the nurses. These
findings suggest that EBP focus in the nursing profession not only
improves patient care, but also can inspire and energize nurses.

Limitations

Limitations stem from the characteristics of the sample and
the nature of qualitative methods. The reflections were from
participants in the IEBPC program. The program provided
education and attention to specific aspects of EBP implementa-
tion (e.g., planning, measuring results). This likely influenced
participant attention to those areas in the reflections, although
not the specific experience described. It also can be assumed
that participants in the program already had interest and some
personal and organizational commitment to EBP. This limita-
tion is mitigated by the fact that many concepts and themes
described here are mentioned in other studies.

Qualitative analysis, used in the current analysis, requires clas-
sification of the raw data by the reviewers. Different individuals
using the same data may arrive at different classification of themes
and concepts. Analysis also involved the distillation of a wealth of
written data to a relatively small set of themes and observations
that cannot describe the full complexity of EBP implementation.

The fact that findings are derived from a variety of different
settings and from EBP projects involving diverse aspects of pa-
tient care is a strength of this analysis. Because the themes are
derived from various situations, they may be relevant in a range
of situations. Data also were obtained at the time individuals
were involved in their EBP implementation projects, providing
reflection on the experience as it occurred. To the authors’
knowledge, the current analysis is the first to record the experi-
ence of EBP implementation as it happened.

Conclusions
Nurses routinely do not implement evidence in practice, and

translating evidence into clinical practice is a challenging process

Discovery About Practice

“We were actually surprised that the nursing staff did not get
100% on the fatigue knowledge assessment.”

“We thought these were things that all nurses knew. We were
wrong.”

Discovery About Each Other

“Our team interactions are providing previously untapped chances to
see each other in a variety of scripted and unscripted roles not al-
ways reflective of the assigned titles we have in our regular work.”

“The multidisciplinary team has been wonderful and helped us
think beyond our own ‘boxes’ of expertise.”

Igniting the Spirit of Inquiry

“Data collection is done. . . . Reading that makes me want to dig
deeper.”

“Exposure to a new knowledge area and way of thinking opens up
countless opportunities.”

“Successful project experience never ends. . . . It leads to other op-
portunities.”

“We were afraid at first that the staff nurses would just complain,
‘What more for me to do?’ But that is not the response we are get-
ting at all. They want to have the information at their fingertips.”

Empowerment Through Evidence

“The most exciting and surprising event was to experience our
stress level decrease once we got into the meat of the evi-
dence and did the grading. We all knew we were experiencing
evidence-based practice at a different level.”

“We are seeing each other grow and gain confidence in a new
area with evidence-based support.”

“We had to be very well versed in our literature knowledge, and
we were able to command this discussion and disallow any ten-
dency to disregard evidence.”

Challenge of Sustaining Change

“How do you sustain a change and make it practice?”
“We are trying to keep the momentum going and find ways to

sustain the change we have made.”
“One of the things we have learned in the past six months is that

sustainability is hard but definitely rewarding, both for the pa-
tients and the organization at large.”

FIGURE 7. Subthemes in the Theme of Discovery

Clinical Journal of Oncology Nursing • Volume 17, Number 5 • Implementing Evidence-Based Practice Change 549

(Fineout-Overholt et al., 2005; Wallin, Profetto-McGrath, &
Levers, 2005). Findings from this work point to several areas
that may be helpful to nurses in planning EBP implementation.
Implementation strategies and critical success factors can help
prepare others and be included in planning. Findings suggest
that a strategy to maintain focus during implementation is
important. As professionals, nurses need to develop solutions
for time constraints commonly reported as barriers. If organi-
zations are motivated, support for dedicated time can facilitate
EBP (Mensik, 2011).

Challenges in EBP implementation cannot be minimized. How-
ever, as shown in this article, EBP implementation also can be
a rewarding and inspirational experience for nurses that fosters
teamwork and collaboration to improve patient care.

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Implications for Practice

u Incorporate knowledge of critical success factors identified
in this article to plan effective evidence-based practice
(EBP) implementation.

u Implement an EBP project for purposeful team building and
interdisciplinary collaboration.

u Create a plan that includes small steps, clear actions, and
deadlines.

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