565243
research-article2015
JPOXXX10.1177/1043454214565243Journal of Pediatric Oncology NursingLulloff and Vessey
Guest Editorial Journal of Pediatric Oncology Nursing 2015, Vol. 32(2) 68–69 © 2015 by Association of Pediatric Hematology/Oncology Nurses Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043454214565243 jpo.sagepub.com
Enough Is Enough
Amanda J. Lulloff, MS, RN1,2, and Judith A. Vessey, PhD, MBA, FAAN1,2 Enough is enough! A thought most of us have had at some point in our careers. This thought may come after the addition of another layer of daily documentation, the assignment of more online educational modules, or an email inbox that has reached capacity for the third time in a month. These tasks—and many more—trigger frustration because they steal time from what we, as nurses, value the most in our practice, providing care to our patients. The care most nurses provide at the bedside is crafted from education, experience, and tradition. But today we know that that is not enough. Evidence-based practice (EBP) is a clinical problemsolving method that incorporates the best available research, professional expertise, and patient preferences to create implementable changes for practice. And the verdict is in. Implementation of EBP improves patient outcomes, reduces costs, and results in greater patient and nurse satisfaction. EBP is no longer just a “nice idea” but is now a requisite to helping ensure quality cost-effective nursing care. The Institute of Medicine has declared the implementation of EBP is a core competency of professional nursing behavior. The Joint Commission embraces an evidence-based approach in its standards and the 2014 Hospital National Patient Safety Goals. Many nursing organizations also incorporate EBP into their professional practice standards and professional certification criteria. The American Nurses Credentialing Center (ANCC) Magnet Recognition Program for nurses requires nurses be able to evaluate, use, conduct, and disseminate research findings as a marker of exemplary professional practice. A position statement from Sigma Theta Tau International, nursing’s premier honor society, affirms the importance of evidence-based approaches in providing optimal care. The Association of Pediatric Hematology/ Oncology Nurses (APHON) has an Evidenced Based Practice and Research Committee supporting the development of EBP guidelines within its membership. In response to this groundswell, pediatric hospital nursing administrations are now embarking on activities designed to change their practice culture—from one rooted in tradition to one that is rooted in EBP principles. This is witnessed through the creation or expansion of nursing research departments, additional training for nursing staff, and dedicated resources for the development and
dissemination of evidence-based protocols. Staff nurses actively engage in nursing projects designed to result in improved practice; their findings are frequently shared in local and national presentations and publications. Yet the nurses who conduct these projects frequently conclude that there is not yet enough quality evidence to actually change practice. The question is why, instead, we choose to cling to tradition. Do we fail to fully understand the dynamic nature of EBP? Are we cowed by the lack of available empiric evidence related to nursing care? Or are we uncomfortable with our ability to critique the evidence and therefore to embrace our conclusions? When is enough evidence, enough to actually change our practice? As nurses we want to provide the best possible care to our patients; however, many of the questions we have about our practice cannot be tested using the gold standard of randomized controlled trials (RCTs) for practical or ethical reasons. In the absence of welldesigned RCTs, we must still be willing to critically appraise the current, available empirical evidence and meld it with our professional expertise and patient preferences. We must then make recommendations for best practices and test them in our own settings, ultimately leading to widespread adoption within and beyond our institutional walls. There are many global questions related to pediatric oncology patients that continue to be asked in different forums: “How often should we be flushing central lines and with what should we be flushing?” “Should neutropenic patients be on special diets/wear masks/stay home from school?” “Can our patients with central lines swim?” Working in various settings, and speaking with nurses from many different institutions, it is clear that even though our patients may have the exact same diagnosis, and be treated with exactly the same medical protocols, they receive very different supportive care 1
William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA 2 Boston Children’s Hospital, Boston, MA, USA Corresponding Author: Amanda Lulloff, 1423 Cambridge St, Apt 5, Cambridge, MA 02139, USA. Email: [email protected]
Downloaded from jpo.sagepub.com at NANYANG TECH UNIV LIBRARY on June 11, 2015
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Lulloff and Vessey interventions. For some of these questions, no empiric evidence currently exists. But for other questions, such as mask wearing and flushing lines, research has been completed and published; findings often conflicting with our practice. Continuing these practices may be easier, or produce less anxiety then changing. At other times when advocating change, we feel as if we lack the authority or are politically blocked from implementing our own practice recommendations. As nurses we must have the courage to consistently evaluate—and reevaluate—our practice based on the best available, current evidence. We cannot be hesitant to propose changes to our practice and demand implementation of our recommendations.
We can support each other in proposing and answering our clinical questions. We can seek mentorship from doctorally prepared nurses to assist in framing and executing our projects. We can look to professional organizations’ endorsements of updated EBP guidelines as a support to overcome institutional barriers to change. Holding on to traditions solely because we think they cannot hurt stagnates our practice and can potentially lead to patient harm. Recognizing when “enough” is “enough” is critical in advancing the practice of oncology nurses. Knowing is not enough; we must apply. Willing is not enough; we must do.
Downloaded from jpo.sagepub.com at NANYANG TECH UNIV LIBRARY on June 11, 2015
—Goethe
research-article2015
JPOXXX10.1177/1043454214565243Journal of Pediatric Oncology NursingLulloff and Vessey
Guest Editorial Journal of Pediatric Oncology Nursing 2015, Vol. 32(2) 68–69 © 2015 by Association of Pediatric Hematology/Oncology Nurses Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043454214565243 jpo.sagepub.com
Enough Is Enough
Amanda J. Lulloff, MS, RN1,2, and Judith A. Vessey, PhD, MBA, FAAN1,2 Enough is enough! A thought most of us have had at some point in our careers. This thought may come after the addition of another layer of daily documentation, the assignment of more online educational modules, or an email inbox that has reached capacity for the third time in a month. These tasks—and many more—trigger frustration because they steal time from what we, as nurses, value the most in our practice, providing care to our patients. The care most nurses provide at the bedside is crafted from education, experience, and tradition. But today we know that that is not enough. Evidence-based practice (EBP) is a clinical problemsolving method that incorporates the best available research, professional expertise, and patient preferences to create implementable changes for practice. And the verdict is in. Implementation of EBP improves patient outcomes, reduces costs, and results in greater patient and nurse satisfaction. EBP is no longer just a “nice idea” but is now a requisite to helping ensure quality cost-effective nursing care. The Institute of Medicine has declared the implementation of EBP is a core competency of professional nursing behavior. The Joint Commission embraces an evidence-based approach in its standards and the 2014 Hospital National Patient Safety Goals. Many nursing organizations also incorporate EBP into their professional practice standards and professional certification criteria. The American Nurses Credentialing Center (ANCC) Magnet Recognition Program for nurses requires nurses be able to evaluate, use, conduct, and disseminate research findings as a marker of exemplary professional practice. A position statement from Sigma Theta Tau International, nursing’s premier honor society, affirms the importance of evidence-based approaches in providing optimal care. The Association of Pediatric Hematology/ Oncology Nurses (APHON) has an Evidenced Based Practice and Research Committee supporting the development of EBP guidelines within its membership. In response to this groundswell, pediatric hospital nursing administrations are now embarking on activities designed to change their practice culture—from one rooted in tradition to one that is rooted in EBP principles. This is witnessed through the creation or expansion of nursing research departments, additional training for nursing staff, and dedicated resources for the development and
dissemination of evidence-based protocols. Staff nurses actively engage in nursing projects designed to result in improved practice; their findings are frequently shared in local and national presentations and publications. Yet the nurses who conduct these projects frequently conclude that there is not yet enough quality evidence to actually change practice. The question is why, instead, we choose to cling to tradition. Do we fail to fully understand the dynamic nature of EBP? Are we cowed by the lack of available empiric evidence related to nursing care? Or are we uncomfortable with our ability to critique the evidence and therefore to embrace our conclusions? When is enough evidence, enough to actually change our practice? As nurses we want to provide the best possible care to our patients; however, many of the questions we have about our practice cannot be tested using the gold standard of randomized controlled trials (RCTs) for practical or ethical reasons. In the absence of welldesigned RCTs, we must still be willing to critically appraise the current, available empirical evidence and meld it with our professional expertise and patient preferences. We must then make recommendations for best practices and test them in our own settings, ultimately leading to widespread adoption within and beyond our institutional walls. There are many global questions related to pediatric oncology patients that continue to be asked in different forums: “How often should we be flushing central lines and with what should we be flushing?” “Should neutropenic patients be on special diets/wear masks/stay home from school?” “Can our patients with central lines swim?” Working in various settings, and speaking with nurses from many different institutions, it is clear that even though our patients may have the exact same diagnosis, and be treated with exactly the same medical protocols, they receive very different supportive care 1
William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA 2 Boston Children’s Hospital, Boston, MA, USA Corresponding Author: Amanda Lulloff, 1423 Cambridge St, Apt 5, Cambridge, MA 02139, USA. Email: [email protected]
Downloaded from jpo.sagepub.com at NANYANG TECH UNIV LIBRARY on June 11, 2015
69
Lulloff and Vessey interventions. For some of these questions, no empiric evidence currently exists. But for other questions, such as mask wearing and flushing lines, research has been completed and published; findings often conflicting with our practice. Continuing these practices may be easier, or produce less anxiety then changing. At other times when advocating change, we feel as if we lack the authority or are politically blocked from implementing our own practice recommendations. As nurses we must have the courage to consistently evaluate—and reevaluate—our practice based on the best available, current evidence. We cannot be hesitant to propose changes to our practice and demand implementation of our recommendations.
We can support each other in proposing and answering our clinical questions. We can seek mentorship from doctorally prepared nurses to assist in framing and executing our projects. We can look to professional organizations’ endorsements of updated EBP guidelines as a support to overcome institutional barriers to change. Holding on to traditions solely because we think they cannot hurt stagnates our practice and can potentially lead to patient harm. Recognizing when “enough” is “enough” is critical in advancing the practice of oncology nurses. Knowing is not enough; we must apply. Willing is not enough; we must do.
Downloaded from jpo.sagepub.com at NANYANG TECH UNIV LIBRARY on June 11, 2015
—Goethe
