Aligning Clinical Practice With Research and Evidence-Based Practice for Frontline Staff

In this Q&A, Deltra Muoki, Ph.D., APRN, AGNP-C, CMSRN, CNE, NE-BC, a member of the Academy of Medical-Surgical Nurses (AMSN) Digital Content Committee, explains evidence-based practice (EBP), its value to the nursing profession, and its impact on patient outcomes. Dr. Muoki also provides advice for implementing EBP in clinical settings.

Can you tell us about yourself and your journey in nursing research, evidence-based practice (EBP), and quality improvement?

Dr. Deltra Muoki: I am a Ph.D.-prepared nursing scholar and adult geriatric primary care nurse practitioner with over 15 years of nursing experience. My journey in nursing started when I participated in Health Occupations Students of America as a high school student. My school also offered a certified nursing assistant (CNA) program supported by the local college, which gave me an opportunity to obtain my CNA certification upon high school graduation. I worked at a long-term care facility during the summer after high school graduation and spent time caring for my grandmother. I found such a sense of pride, compassion, and gratitude in taking care of others. I knew that I wanted to continue advancing my nursing education.

I graduated from Prairie View A&M University with my Bachelor of Science in nursing. My first job as a registered nurse was at a large academic medical center on a medical-surgical floor working the night shift. I quickly advanced to the charge nurse on the unit. I absolutely love medical-surgical nursing because it allowed me to experience a variety of disease processes and learn how to navigate the care of those medically complex patients.

A couple of years later, I began my tenure in oncology nursing at a comprehensive cancer center in the department of gastroenterology, hepatology, and nutrition. After graduating from Texas Woman’s University with my Master of Science as an adult gerontology nurse practitioner, I worked in community-based healthcare settings. I later returned to work at the comprehensive cancer center in the same department with a special focus on percutaneous endoscopic gastrostomy (PEG) tube placement and management.

After graduating with my Ph.D. in nursing science, I entered nursing academia as an adjunct faculty, faculty, and then an undergraduate nursing program director at a large public university. I was able to gain a different perspective of nursing and merge that with my clinical nursing knowledge. I am currently the nurse scientist for an acute care, community-based hospital that is part of a large hospital system.

My research interest focuses on healthcare disparities, patient outcomes, and innovative pedagogies in nursing education. These populations not only exist in the clinical setting but also in academia. To address these needs, my colleague and I started leading a grant-funded qualitative research study to examine cultural representation and healthcare experiences for the Black trans, non-binary, and trans-experience community. Data collection is complete, with data analysis currently ongoing.

What is EBP, and how does it shape the care that medical-surgical nurses provide to patients each day?

Dr. Muoki: EBP is implementing an intervention from the literature to address the same or closely related problem in your practice or at your facility. The evidence in the literature is combined with clinical experience, ethical consideration, and patient preferences. EBP suggests that the outcomes in the literature will produce meaningful impacts for your specific patients and their families. EBP in nursing promotes clinical judgement, shared decision-making with patients, nurse empowerment, and advancement of the nursing profession.

Can you tell us about a time when you were involved in bringing EBP or research findings to your practice area?

Dr. Muoki: It was during my practice as a nurse practitioner that I identified my passion and desire for systemic change. I identified a gap between the literature, clinical practice, and patient outcomes. In particular, the patient and family decision-making processes were not clear regarding PEG tube placement. This led to long-term effects on the patient and family and adequate care of the PEG tube. I wanted to understand the perspectives of those individuals who had lived the experience, as this would help me identify any areas and methods for improvement. I conducted a qualitative study with findings that garnered significant attention. The study findings were used to tailor the pre- and post-procedure experience for those patients and their families who were candidates for PEG placement. The results of the study and the integrative literature review were both published.

What guidelines are used to promote the incorporation or exploration of EBP in your organization?

Dr. Muoki: Support and resources are crucial to the implementation and sustainability of EBP within the organization. My organization has a nurse scientist who serves as a consultant, educator, and mentor for clinical inquiry. Frontline nurses are encouraged to identify areas for opportunities and potential interventions from the literature to address the problem. The nurse scientist provides oversight and guidance throughout the journey, from project development to dissemination. The magnet program director is also available as a resource and mentor to help identify measurable outcomes.

In addition to these resources, the quality department is available to help project leads and teams identify areas for improvement by analyzing quality metrics. The department of clinical education is instrumental in supporting nurses on the frontline as they develop, implement, and sustain EBP. Also, the performance excellence team collaborates with team members to assist with project planning and data management.

What additional types of EBP topics, processes, workflows, and tools can be used to advance nursing excellence and support effective teams?

Dr. Muoki: Implementation science has been around for many years but is becoming a growing topic of discussion in the nursing profession. It examines how to incorporate EBP strategically and methodically into daily work so that it becomes ingrained in the culture.

Sustainability is essential to improving and maintaining outcomes. One important aspect of implementation science focuses on being proactive and identifying barriers prior to incorporating best practices. The aim is to preemptively address those roadblocks.

Mentorship is also a valuable tool to advance nursing excellence. It is often said that “we don’t know what we don’t know.” Mentorship helps to fill this gap when you may not know the right questions to ask to get the information you need.

In your opinion, what are the key challenges in implementing EBP in a clinical setting, and how do you overcome them?

Dr. Muoki: The key challenges in implementing evidence are lack of buy-in from key stakeholders, limited time for frontline staff, and competitive resources. The key stakeholders will vary depending on the target population. However, the literature does clearly explain that buy-in and support is crucial to sustainability. It is essential that you know your audience, and be sure to share the details of the project so stakeholders can ask questions and receive feedback.

Time is also limited for frontline nurses as they provide direct care for their patients and families. Organizations are devising innovative approaches to provide protected time to frontline nurses that allow them to focus on scholarly nursing work.

Grant funding to financially support EBP is competitive and requires meticulously crafted applications. Some organizations provide resources and support for grant writing through their nurse scientist and research centers. Professional nursing organizations and government agencies often release a request for application or request for proposal that support nursing projects or research. They provide specific eligibility criteria and instructions for completion of the application and proposal. Novice applicants may feel unsure or hesitant to apply due to lack of experience. I always encourage nurses to apply for grants because even if their initial application is not funded, they can learn from the experience and improve on the next application. Practice may never make perfect, but it does make it better.

How do you stay informed about the latest evidence and research findings relevant to nursing practice?

Dr. Muoki: I love to learn and soak up anything that anyone is willing to teach and share. I am a member of several shared governance councils, as well as the co-chair of our system research and EBP council. My colleagues and I constantly share information via this platform. I am a peer reviewer for a couple of professional nursing journals, which also allows me to stay abreast of current issues in healthcare. As a current committee member of the AMSN Digital Content Committee, I source and review content from frontline staff, which helps me remain current on the latest issues. I also conduct original research to gain new knowledge and attend conferences where information is shared in a formal setting.

For more information about implementing evidence-based practice, check out these past episodes of the Med-Surg Moments Podcast:

• Episode 15: Defining and Promoting Evidence-Based Practice
• Episode 41: How to Implement Evidence-Based Practices