Evidence Based Practice in Child Health Care

Tamara J. Hall 

APN Role

Utilize evidence based practice guidelines to manage the comprehensive health care needs of children ages birth to 19 years in a culturally sensitive manner within the medical home model that promotes interdisciplinary collaboration.

Research, Evidence Based Practice, and Quality Improvement

Research is the methodical examination of established information or new questions with the intent to produce answers to new clinical questions or confirm and enhance existing knowledge (Polit & Beck, 2017; Shirey et al., 2011). Topics of interest for research are generated by questions arising from issues encountered in clinical practice (Shirey et al., 2011). Evidence based practice is founded on combining the results from several research studies about a specific topic with patient requirements to arrive at a clinical decision that best fits the specific situation (Hamric, Hanson, Tracy, & O’Grady, 2014; Mateo & Foreman, 2014). The purpose of quality improvement is to enhance procedures central to systems in a specific unit, such as a certain group of patients or a clinic within a larger organization (Hamric et al., 2014; Shirey et al., 2014).

EBP, Research, and QI in APN Role

Advance practice nurses utilize evidence based practice, research, and quality improvement to make decisions regarding patient care that are based in on combination of many research studies with the goal of promoting the best possible outcome for each patient under their current circumstances. In my practice setting, providers discuss the latest research on a quarterly basis and as a group decide on the approach to use for specific clinical situations. Support staff also discuss new recommendations regarding procedures performed within the clinic and update the related policies to align with the updated guidance.

Outcome Measures

In my practice setting, the provider specific outcomes measured based on an ongoing quality improvement initiative are patient satisfaction with: provider explanation; time provider spent during the appointment; provider knowing patient history; and provider reviewing medications with the patient. These outcomes are assessed on a monthly basis with emailed surveys that are sent to each family seen by a provider in the clinic. Results are collated and reviewed with each provider individually and collectively at staff meetings. When negative trends are noted, the group discusses possible changes aimed at improving the specific outcome. Unfortunately, these changes are not based on current evidence in the literature. Positive trends are also discussed and any activities supporting the improving outcomes are continued.

EBP Application

A specific example of how evidence-based practice is utilized in my practice is the diagnosis and management of bronchiolitis in children. Prior to 2014, a trial of bronchodilator was recommended in the management of acute bronchiolitis. The American Academy of Pediatrics (2014) revised the guideline based on current evidence and now recommends providers not utilize bronchodilators in the treatment of bronchiolitis. Evidence that the medications had only transient effect but did not change overall outcome, combined with the adverse effects of bronchodilators prompted this change in recommended management. After this change to the guideline was published the update was discussed in a meeting of all the pediatric providers in the organization. Reasons behind the change were presented and the recommendation was made that all pediatric providers change their practice to align with the current practice guideline. Ideally, a formal chart review of all children diagnosed with bronchiolitis would be conducted 3 months after the recommendation was made to assess the percentage of providers following the new guideline. This chart review was mentioned but was not conducted.

References

Hamric, A. B., Hanson, C. M., Tracy, M. F., & O’Grady, E. T. (2014). Advanced practice nursing: An integrative approach (5^th ed.). St. Louis, MO: Saunders Elsevier.

Mateo, M. A., & Foreman, M. D. (2014). Research for advanced practice nurses: From evidence to practice (2^nd ed.). New York, NY: Spring Publishing.

Polit, D.G., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10^th ed.). Philadelphia, PA: Lippincott Williams & Wilkins

Ralston, S. L., Lieberthal, A. S., Meissner, H. C., Alverson, B. K., Baley, J. E., Gadomski, A. M., … Hernandez-Cancio, S. (2014). Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics, peds.2014-2742. https://doi.org/10.1542/peds.2014-2742

Shirey, M. R., Hauck, S. L., Embree, J. L., Kinner, T. J., Schaar, G. L., Phillips, L. A.,…McCool, I. A. (2011). Showcasing differences between quality improvement, evidence-based practice, and research. The Journal of Continuing Education in Nursing, 42(2). 57-68. http://dx.doi.org/10.3928/00220124-20100701-01