Creating internal expertise

This excerpt was taken from the book, Evidence-Based Practice in Nursing: A Guide to Successful Implementation

When administrative support is in place and nurses are becoming excited about undertaking projects and changing practice, start developing expertise about evidence-based practice. Initially, nurses could learn to navigate electronic databases and could investigate journals that are available in either print or electronic copy in their organization. If no journals or databases are available, the same outcome can be obtained by visiting a local hospital that is doing EBP and seeing what journals and electronic databases they have in place. If the organization has partnered with a local college of nursing, have nursing staff members schedule an appointment with the reference librarian to learn how to access the available resources. If there is no dedicated medical or nursing library readily available, the local community library may have resources, such as PubMed, that can help you begin to build evidence-based practice resources.

The EBP/nursing research council can organize a list of available journals and databases and start coordinating educational sessions. One approach that works with nurses who are novices with research is to focus the initial EBP/nursing research council meetings on education. Emphasizing education rather than on identifying research questions, selecting an EBP model, reviewing protocol, or designing studies allows staff nurses the time to develop their skills. This strategy helps ease interested staff nurses into a contributory role as they participate in the work of the group and build their skill levels. Initial topics for the educational sessions could include the following:

  • How do I undertake a literature search?
  • What is evidence-based practice?
  • Is evidence-based practice for me?
  • Why is evidence-based practice important to my patients and to our organization?
  • Why do we have to do patient care, charting, passing medications, and now evidence-based practice? Who has time?
  • How do I get started?
  • What resources do I need?
  • What resources are available?

One of the biggest challenges nurses face is learning how to search the literature. Having a librarian or educator come to the meeting with a laptop computer and do a “real time” search will build nurses’ confidence in the process of searching electronic resources. As the group continues to develop knowledge and awareness, more advanced topics can be added, such as:

  • Levels of evidence
  • Critique of qualitative research articles
  • Critique of quantitative research articles
  • Critique of research proposals
  • Protection of human subjects
  • Ethical issues in nursing research
  • Reliability and validity
  • Overview of models of EBP
  • Formulating an EBP or research question
  • Synthesizing the literature
  • Developing a clinical practice guideline

Three major barriers often prevent research from being translated into practice: difficulty finding research articles, uncertainty about evaluating research, and difficulty with interpreting findings. Participation in journal clubs enhances nurses’ confidence in all of these areas and prepares nurses for critiquing research, which is an essential component of evidence-based practice. When conducting journal clubs, a group of nurses meets regularly to discuss and critique articles from nursing research journals. Articles are evaluated for scientific integrity and relevance to nursing practice.

The journal club format allows members of the nursing staff to become active participants in EBP. It serves as a way to bridge research and practice and thereby fosters the application of research findings into the practice setting. The traditional approach to a journal club is for nurses to meet as a group for about an hour to critique an article. However, practice realities can make this difficult to accomplish on a routine basis in some clinical settings, so after the group is comfortable reading, discussing, and evaluating articles, consider alternative approaches, such as an electronic online journal club.

Another strategy that helps nurses develop expertise in evidence-based practice is to have them develop policies and procedures. Encouraging nurses to develop or update policies and procedures using the latest research findings helps introduce them to the research literature. Working together in small groups, nurses can encourage and support each other in interpreting the findings from various research studies and developing evidence-based practice.

Once nurses have become comfortable reading and discussing articles, they are ready to start doing formal critiques of the nursing literature. Guidelines for critique of research articles can also be found in the EvidenceBasedResourceCenter on Additional guidelines are available in nursing research textbooks or can be developed for your organizational needs by an advance practice nurse or research consultant. For example, before using nursing research articles for policies and procedures or to validate or change practice, one must ask the following questions:

  • Where was the study conducted? What was the setting (e.g., academic medical center, community hospital, rural hospital, or long-term care facility)?
  • Who was in the study population? Were study participants similar to patients cared for in this organization?
  • How does the study contribute to the body of nursing knowledge? Do the study findings make sense?
  • What are the implications for nursing practice/education/research?
  • What additional questions does the study raise?
  • Does the empirical evidence presented in this article support a change in practice?
  • What resources would be required to implement the change?
  • Would the benefits of this practice change or outweigh the risks to patients?
  • What will be the outcome of this practice change on nurses, patients, or the organization?
  • How will the practice change be evaluated?

Another way to develop nurses’ skills is to encourage nurses to be active participants in any evidence-based practice efforts being conducted by multidisciplinary teams. For example, the surgeons in a particular hospital might conduct an improvement effort related to preventing surgical site infections. Including nurses in this effort provides them with an opportunity to learn while they contribute to the effort. Examining problems from the multidisciplinary perspective also benefits patients and their families by ensuring best practices.

Getting started in research and evidence-based practice begins by identifying problems and prioritizing projects. Identifying situations that result in negative or unexpected clinical outcomes or by examining hunches made from clinical observations is another important way to develop research questions. Perhaps one of the most important ways to become successful in research is to ask questions that are of interest and importance. More important than knowledge about research, then, is asking questions that have true clinical meaning and pursuing them with great passion (Beyea, 2000).

Editor’s note: This excerpt was adapted from the book, Evidence-Based Practice in Nursing: A Guide to Successful Implementation. To find out more about the book and to order a copy visit .