EVIDENCE Extending Valid Infrastructures to Deploy Evidence in Nursing homes and create a Culture of Evidence

RELEVANCE: In recent years the attention and demands on evidence based practice (EBP) has been growing, but still in nursing homes, the nursing discipline has difficulties to actually apply EBP in their daily routines. This negatively affects quality and safety of nursing care. An EBP culture within the nursing discipline could contribute positively to the quality and safety of care. Further, we use the term evidence based nursing (EBN) as this proposal focusses on EBP within nursing discipline. OBJECTIVE: To improve the EBN culture in nursing homes by further expansion of the present nursing research infrastructure. SETTING: Four nursing homes, with at least three care teams, participating in two research networks (TopCare; UKON). The nursing discipline is responsible for the nursing care and consists of nurses with different EQF levels of education (European Qualification Framework), such as nursing scientists, nurse practitioners, baccalaureate nurses, licensed nurses, nurse assistants and nursing aids. DESIGN: Participatory action practice research design with mixed methods data collection at baseline and 15-month post measurement with feedback loops during the implementation period. INTERVENTION: Practice Development (PD) approach is a systematic approach based on nine principles with the aim to develop an EBN culture based on different types of evidence (e.g. research, professional expertise, patient experiences & experiences local context). This developmental process is facilitated by an external facilitator (experienced in change management) and an internal facilitator (nurse EQF 5-7) appointed for at least 8 hours per week by the nursing home. The facilitators will involve all nurses, with different levels of education, in the development of an EBN culture, making use of personal qualities, creativity and professional competencies. Through this participatory learning process daily routines of individual professionals as well as teams will change and lead to sustainable improvements. Through the PD approach the research infrastructure of the two research networks will be expanded on creating a specific EBN culture in nursing homes. The external facilitator, together with the researcher, will support and provide feedback to the internal facilitators in the process of creating an EBN culture in collaboration with the care teams. RESEARCH QUESTIONS: 1. What is the effect of the PD approach in nursing homes on EBN culture within nursing discipline? 2. What is the effect of PD approach on a nursing research infrastructure (i.e. research utilization)? 3. What is the effect of the PD approach in nursing homes on nursing leadership? 4. What is the effect of EBN culture within nursing discipline on patient experience and tailored ‘basic nursing care’ outcomes? 5. Which factors influence the application and outcomes of the PD approach in relation to EBN culture within nursing discipline and research infrastructure in nursing homes? OUTCOMES: Primary effect outcomes (q1; q2) : 1) EBN culture, measured by EBPAS; 2) Research utilization, measured by RUQ. Secondary effect outcomes (q3; q4): 1) Nursing leadership, measured by MLQ and LPI; 2) Patient experiences by means of 3 domains of the CQ Index; and 3) Tailored ‘basic nursing care’ outcomes, measurements depend on the topic teams choose to improve. Process outcomes (q5): 1) description of the PD approach in relation to nursing research infrastructure and EBN culture, including barriers and facilitators by means of the Barrier Scale and qualitative data gathered with interviews and logbooks. PRODUCT: A handbook for nursing discipline employed by nursing homes, including practical tools and on-the-job-training modules. DISSEMINATION: A mixture of dissemination strategies will be used aimed at different types of stakeholders (practice, education, research) through websites and newsletters of the partners, the organization of an invitational conference, the integration of results in educational curricula, inclusion of the handbook in the toolkit ‘Excellent Care’ from the Dutch association of nursing (V&VN), publications in (inter)national vocational and scientific journals and the presentation of the results on relevant congresses. FEASIBILITY: Although the current project is ambitious, for several reasons this project can be conducted successfully: 1) two networks (UKON, TopCare) and four nursing homes have been involved in preparation of the plan and are eager to participate as it is an opportunity to improve quality of nursing care in nursing homes; 2) it elaborates on the results of other projects within the ‘From Knowledge to Action II’ program (Basic Care Revisited; Nurses on the Move), which gives the opportunity to increase knowledge transfer in early stages of the project; and 3) stakeholders from practice, education and research are involved in Steering Committee and Advisory Board. Besides as a team we have collaborated in previous projects successfully.