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The Value of Evidence-Based Practice in Military Nursing

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The Value of Evidence-Based Practice in Military Nursing MILITARY MEDICINE, 185, S2:4, 2020 The Value of Evidence-Based Practice in Military Nursing COL Melissa Hoffman, ANC* ; CAPT Debra Roy, NC, USN† ; Col Deedra Zabokrtsky, USAF, NC‡ ; Col Jennifer Hatzfeld, USAF, NC§ In an unpredictable and complex global environment where lished literature for the best evidence, working with a team our military force must remain globally engaged and adaptive, to synthesize the literature, and implementing a policy or maintaining the readiness of the force is essential. Within practice change based on the evidence. These are not skills the military health system (MHS), the focus is on quality that are unique to the military but are an important part of Downloaded from https://academic.oup.com/milmed/article/185/Supplement_2/4/5835926 by guest on 27 September 2021 health care for our beneficiaries, lower cost, and clinical nursing practice. Nurses with advanced nursing degrees have skills sustainment.1 Those goals support our overall mission an additional 11 competencies that reflect their additional of generating a readily deployable force with a supporting responsibility to provide evidence-based care and the ability medical force ready to deliver health care anywhere and at any to independently evaluate and synthesize evidence.6 time. Evidence-based practice (EBP) provides an important Regardless of educational level, improvement of clinical tool for our health care professionals to maintain a readiness knowledge and processes through EBP is a daily occurrence focus, develop and maintain clinical skills, and provide care across military health care and is led by clinical staff nurses, that is relevant to both the military and civilian health care clinical nurse specialists, nurse scientists, and many other communities. The purpose of this editorial is to underscore dedicated members of the health care team. Leaders and the support from military nursing leadership to pursue EBP clinicians at military treatment facilities (MTFs) recognize initiatives and the importance of incorporating evidence into the vital role they play as clinical platforms for readiness and decisions made at all levels. support the role EBP plays in keeping the clinical staff mission EBP is a systematic way to approach a clinical prob- ready. From novice to expert, EBP is woven into professional lem or question that includes a systematic search for pub- development beginning with the Clinical Nurse Transition lished medical literature and internal data that can address Program continuing into civilian education programs, profes- the topic, careful evaluation of the strength of the evidence, sional development, and beyond. and then a synthesis of the findings that can inform clini- cal practice, change (or support) a local policy, or make a leadership decision.2 Although more formal processes and IMPACT ON NURSING PRACTICE algorithms are traditionally taught within nursing education,3 The benefits of EBP within health care have been well estab- these same basic principles form the foundation for evidence- lished and are associated with improved patient outcomes, based medicine4 and evidence-based management.5 Although lower costs, and high-quality care.7 Additionally, nurses’ the steps of EBP are not specific to nursing, they are a engagement in their facility, through participating in efforts critical element of military nursing when it comes to the such as EBP initiatives are positively associated with patient nursing profession, military readiness, and growing future safety8 and nursing outcomes such as job satisfaction and leaders. retention.9 Clearly, the evidence supports that EBP is an Evidence-based competencies for EBP have been estab- important element of nursing care within the MHS. lished for both nursing staff and advanced practice nurses.6 Through EBP, military nurses have also contributed to For all nursing staff, there are 13 defined competencies, which the body of evidence to advance nursing practice in many include the ability to ask a clinical question, search pub- different areas. In 2010, the TriService Nursing Research Program published a supplement in Nursing Research that shared the results of six EBP projects accomplished within MTFs, including updating ICU visitation policies,10 devel- *U.S. Army Nurse Corps, Defense Health Headquarters, 7700 Arlington 11 Blvd, Falls Church, VA 22042 oping guidelines for enteral tube feedings, and preventing †U.S. Navy Nurse Corps, Defense Health Headquarters, 7700 Arlington ventilator-associated pneumonia.12 With just these three pub- Blvd, Falls Church, VA 22042 lished articles, an analysis in the Web of Science indicates that ‡ U.S. Air Force Nurse Corps, Defense Health Headquarters, 7700 Arling- they have been referenced over 35 times in scholarly health ton Blvd, Falls Church, VA 22042 care journals and informed nursing practice in the United §TriService Nursing Research Program, Uniform Services University, 4301 Jones Bridge Road, Bethesda, MD 20814 States, Canada, the United Kingdom, Australia, Spain, The The views expressed are those of the author and do not reflect the official Netherlands, South Africa, South Korea, Malawi, and many policy or position of the TriService Nursing Research Program, USUHS, the more. Department of Defense, or the U.S. Government. More recent publications have shared findings from EBP doi:10.1093/milmed/usz190 Published by Oxford University Press on behalf of the Association of initiatives completed at MTFs on topics including develop- 13 Military Surgeons of the United States 2020. This work is written by (a) US ing a behavioral emergency response team, implementing Government employee(s) and is in the public domain in the US. delayed newborn bathing,14 and emergence delirium screen- 4 MILITARY MEDICINE, Vol. 185, May/June Supplement 2020 The Value of Evidence-Based Practice in Military Nursing ing.15 Each of these efforts address a topic relevant to the of health within the deployable force and the global health military nursing setting and a military population but can also care community. Many military nurses have gathered a wealth inform nursing care in settings well beyond the military and of experience in extremely challenging and austere environ- even in the international setting. This small but representative ments. This experience and expertise serves as a valuable sample of published EBP efforts serves as an example of the resource that can inform the translation of evidence into a much larger contribution that military nurses make to advance practice setting that will be a challenge for clinicians that the broader nursing profession. deploy for the first time. As a military nursing community, nursing leaders must encourage our experienced clinicians to translate that knowledge base into the next wave of innovative IMPACT ON MILITARY NURSING AND READINESS clinical practices that will improve the health care of our Downloaded from https://academic.oup.com/milmed/article/185/Supplement_2/4/5835926 by guest on 27 September 2021 In addition to informing the profession of nursing, there are military community. many reasons why EBP is essential to a military nurse’s professional skill set. Military nurses develop and hone their clinical skills and critical thinking ability at established MTFs, IMPACT ON LEADERSHIP DEVELOPMENT which are akin to a civilian hospital system. This is a time Beyond the impact on readiness, EBP also provides a critical for nurses to gain confidence and knowledge. Their ability leadership development opportunity essential for long-term to ask questions and look to the literature for answers in a success in the military. In the military, strong leadership traits “safe” and “controlled” environment is crucial to developing include the ability to develop and operationalize strategic an officer’s ability to question, challenge, and advocate for a plans; anticipate challenges to reaching the objective and patient or practice when needed in both the MTF and the oper- mitigate them; develop, mentor, and optimize team members; ational arena. Military nurses must understand what the best and the ability to mobilize a group of people to meet a goal.17 practices are in the hospital environment so they can mimic These skills, once learned, are core to leadership success at these practices to the best of their ability in environments every level. Leadership ability will grow and change over time, that are not “controlled” and may have limited resources. as an individual practices these skill sets with larger and more This culture of enquiry not only helps identify how civilian complex initiatives, the officer is more likely to be successful best practices can be implemented in deployed environments in adapting to and meeting mission requirements. but also provides an opportunity to explore ways to optimize These leadership skills mirror the skills required to those practice in an austere or dynamic environment when the “usual required to be successful throughout EBP process. Once a care” is not available or practical. A solid understanding of the question or problem has been identified, there is a need to eval- evidence that guides individual nursing practice also provides uate the environment, which includes a review of evidence, the military nurse with the knowledge and ability on how to an assessment of a potential practice gap (what the facility appropriately tailor their nursing care regardless of the setting is doing versus what the best practice advises), the need to or circumstances—during transport,
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