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Inquiry for evidence-based practice
Applied Nursing Research 20 (2007) 109 www.elsevier.com/locate/apnr
Editorial
Inquiry for evidence-based practice There is much current discussion regarding the new Doctor of Nursing Practice (DNP) degree programs to prepare nurses at the highest level of clinical practice. Although much of the debate has been centered on distinctions in types of degrees (e.g., the research doctorate and the practice doctorate), what has not been thoroughly delineated is the focus of inquiry that should be central to DNP program development and student learning. Evidencebased practice (EBP), internationally acclaimed as the gold standard for quality in patient care delivery and outcomes of care, can serve as the best model for practicelevel inquiry. One of the first steps in the process of change is the recognition of the need for cultural change—an awareness that the very foundation on which nursing practice is based needs to be questioned. Evidence-based practice requires a culture of inquiry, a culture in which professional nurses develop and practice critical thinking skills as well as clinical decision making, role model the questioning attitude and behaviors, and are continuously exposed to research and best evidence. Nurses must be encouraged to ask more of themselves as well as their decisions and to nurture the questioning mind, spirit, and culture. Evidence-based practice, by definition, requires clinical expertise and skills in applying the best available external evidence gathered from systematic research. Neither clinical expertise alone nor research application skill alone is sufficient. The foundational clinical expertise is what distinguishes nurses prepared with the practice doctorate from those prepared with the research doctorate. Just as there are different educational programs, there should be differences in the research generated by the graduates. Evidence-
0897-1897/$ – see front matter © 2007 Published by Elsevier Inc. doi:10.1016/j.apnr.2007.04.002
based practice best serves as the foundation for inquiry for expert clinicians, but it can never replace clinical expertise. What are some examples of the avenues for inquiry for the DNP graduate with expertise in EBP? Key areas of concern would include movement from efficacy to effectiveness research. It is critical that we determine the transportability of efficacious treatments to usual-care settings. The second stage of research would be the movement from effectiveness to dissemination studies. Premature dissemination is to be avoided. Thorough analysis of the practice conditions that might affect translation into practice, in different environments of care and under different conditions, is necessary prior to conducting dissemination studies. Potential barriers to success in dissemination should also be addressed prior to study implementation. Key elements to be considered in dissemination research include the characteristics of the intervention, the clients, the practitioners, and the service delivery system. Outcome measures related to all of these dimensions are important. None of these dimensions alone is sufficient for evaluation. Isolation of one component would characterize the stage of research on treatment efficacy rather than research related to transportability or dissemination. The current development of DNP programs provides an opportunity to partner researchers with expert clinicians, all engaged in the development of science. Although the primary skills used (either the traditional research methodologies or the EBP methods) are different, the goal of enhanced clinical care achieved through quality outcomes is shared. Joyce J. Fitzpatrick (Editor)
Q1; Q2
Editorial
Inquiry for evidence-based practice There is much current discussion regarding the new Doctor of Nursing Practice (DNP) degree programs to prepare nurses at the highest level of clinical practice. Although much of the debate has been centered on distinctions in types of degrees (e.g., the research doctorate and the practice doctorate), what has not been thoroughly delineated is the focus of inquiry that should be central to DNP program development and student learning. Evidencebased practice (EBP), internationally acclaimed as the gold standard for quality in patient care delivery and outcomes of care, can serve as the best model for practicelevel inquiry. One of the first steps in the process of change is the recognition of the need for cultural change—an awareness that the very foundation on which nursing practice is based needs to be questioned. Evidence-based practice requires a culture of inquiry, a culture in which professional nurses develop and practice critical thinking skills as well as clinical decision making, role model the questioning attitude and behaviors, and are continuously exposed to research and best evidence. Nurses must be encouraged to ask more of themselves as well as their decisions and to nurture the questioning mind, spirit, and culture. Evidence-based practice, by definition, requires clinical expertise and skills in applying the best available external evidence gathered from systematic research. Neither clinical expertise alone nor research application skill alone is sufficient. The foundational clinical expertise is what distinguishes nurses prepared with the practice doctorate from those prepared with the research doctorate. Just as there are different educational programs, there should be differences in the research generated by the graduates. Evidence-
0897-1897/$ – see front matter © 2007 Published by Elsevier Inc. doi:10.1016/j.apnr.2007.04.002
based practice best serves as the foundation for inquiry for expert clinicians, but it can never replace clinical expertise. What are some examples of the avenues for inquiry for the DNP graduate with expertise in EBP? Key areas of concern would include movement from efficacy to effectiveness research. It is critical that we determine the transportability of efficacious treatments to usual-care settings. The second stage of research would be the movement from effectiveness to dissemination studies. Premature dissemination is to be avoided. Thorough analysis of the practice conditions that might affect translation into practice, in different environments of care and under different conditions, is necessary prior to conducting dissemination studies. Potential barriers to success in dissemination should also be addressed prior to study implementation. Key elements to be considered in dissemination research include the characteristics of the intervention, the clients, the practitioners, and the service delivery system. Outcome measures related to all of these dimensions are important. None of these dimensions alone is sufficient for evaluation. Isolation of one component would characterize the stage of research on treatment efficacy rather than research related to transportability or dissemination. The current development of DNP programs provides an opportunity to partner researchers with expert clinicians, all engaged in the development of science. Although the primary skills used (either the traditional research methodologies or the EBP methods) are different, the goal of enhanced clinical care achieved through quality outcomes is shared. Joyce J. Fitzpatrick (Editor)
Q1; Q2