Evidence-Based Health Care
Evidence-Based Health Care
Expertise in Evidence-Based Health Care
Expertise in Evidence-Based Health Care
Why do we need this kind of supporting structure for evidence-based practice?
The need for evidence-based practice (EBP) is emphasized in all health care. Many barriers relating to EBP are identified, among them lack of time and skills for searching evidence (Kajermo et al. 2008). In addition, there exists a misunderstanding concerning the process of utilizing evidence. Nurses may think, as was previously taught in evidence-based courses, that they have to define the problem by themselves, search for the evidence, appraise its methodological quality, interpret it and make conclusions before applying the evidence into practice (Heiwe et al. 2011). Such misunderstandings keep up barriers to evidence-based practice due to an ever-increasing workload and simultaneous shortage of staff.
The titles, roles and tasks of different type of experts in healthcare are inconsistent both nationally (Finland) and globally. Lack of consistency creates barriers to utilization of experts’ competencies. Consequently, this inhibits the evaluation of the effect of expertise position on patients’, staffs’ and organizational outcomes (Donald et al. 2010). In the table attached, different kinds of titles, descriptions and rationales for the experts’ roles are introduced based on international literature. The aim of the table is to introduce the issues for further discussion in order to enhance descriptions relating to the roles, tasks and rationales for different expert positions in Finnish social and health care.
The Action Model of Expertise (AME)
The current understanding relating to evidence-based practice is based on collaboration between people with different competencies (Medves et al. 2010). In Finland, the Ministry of Social Affairs and Health (2009) published the National Nursing Action Plan for the years 2009-2011 with the aim of increasing the effectiveness and attraction of nursing by means of management. In the Action Plan an Action Model of Expertise (AME) was introduced as a means of facilitating evidence-based health care. The action model consists of the roles of four different types of experts, their core competencies, emphasis on competency and actions in implementation of EBP (Figure 1).
In addition, the model was supplemented by indicating the focus of action of different types of experts. The focus of action of nurses in clinical care and specialized nurses in clinical care is on patients and clients as a means of utilizing evidence-based knowledge in their care. The focus of action of the next two expert groups, clinical nurse specialists and specialists in clinical nursing science, is on staff and organization as a means of disseminating evidence-based knowledge, facilitating its implantation and development of care.
In practice, among these different types of experts in evidence-based health care there are groups of professionally competent nurses whose competency in implementing and developing evidence-based practice is still evolving.
The AME in evidence-based health care: an example
As an example of utilizing the action model of expertise (AME) in evidence-based health care, an action model of improvement of EB hand hygiene practices is introduced. In 2010 Oulu University Hospital (OUH) joined the Finnish Centre of the Joanna Briggs Institute hosted by the Nursing Research Foundation. In order to pilot the tools for implementation of EBP developed by the JBI, a development programme was established in collaboration between the Nursing Research Foundation and Oulu University Hospital.
The programme was based on close collaboration between a clinical nurse specialist and a specialist in clinical nursing science. The first worked as a nursing director in a hospital infection control unit. She had advanced skills and knowledge concerning infection control in the hospital. The latter had the role of bridging scientific and practical knowledge in evidence-based practices. She also represented expertise in developing and applying the tools developed by the JBI into a Finnish health care context.
In the OUH, nurses specialized in infection control were recruited to continuous quality improvement. This involved evaluating hand hygiene practices on a regular basis and reporting the findings in the JBI-PACES tool as well as planning the changes needed in collaboration with the unit director and the department head.
The participants also inform nurses in clinical care and other staff on how to implement correct protocols in hand hygiene.
Seamless collaboration between different types of experts
The key point of the AME is seamless collaboration between different types of experts. The model allows all of them to focus on their own basic duties, whether they consist of direct patient care or disseminating evidence into practice. The EBP is realized in work at point-of-care; the experts and others working in patient care thus need evidence-based knowledge in a synthesized form, as systematic reviews and guidelines. The other types of experts are involved in searching, appraising, synthetizing and disseminating the evidence for them. The AME is aimed at improvement of hand hygiene in the hospital and simultaneously at informing the participants about utilizing the tools for EBP developed by the JBI. The outcome measures will focus on infection rates, costs of care caused by hospital-acquired infections and the length of hospitalization.
Heiwe S, Kajermo KN, Tyni-Lenne R, Guidetti S, Samuelsson M, Andersson I-L, Wengström Y. 2011. Evidence-based practice: attitudes,knowledge and behavior among allied health care professionals. International Journal of Quality in Health Care 23(2), 198- 209.
Kajermo KN, Unde’n M, gardulf A, Eriksson LE, Orton M-L, Arnetz BB, Nordström G. 2008. Predictors of nurses’ perceptions of barriers to research utilization. Journal of Nursing Management, 16, 305-314.
Medves J, Godfrey C, Turner C, Paterson M, Harrison M, MacKenzie L, Durando P. 2010. Systematic review of practice guideline dissemination and implementation strategies for healthcare teams and team-based practice. International Journal of Evidence-Based Healthcare 8, 79-89.
Ministry of Social Affairs and Health. 2009. Increasing the effectiveness and attraction of nursing care by means of management. An action plan for the years 2009–2011. [In Finnish]. Sosiaali- ja terveysministeriön julkaisuja 18.