Evidence-Based Practice Position Statement

he faith community nurse (FCN) of faith community (ANA & HMA, supports, applies, and engages in 2012). Standard 13 of the Faith Community outcomes to apply it in the best possible TEvidence-Based Practice. Nursing Scope and Standards of Practice states way; and What is Evidence-Based Practice? that the FCN integrates evidence and research • shares peer-reviewed evidence with Evidence-Based Practice (EBP) is a problem- into practice (ANA & HMA, 2017, p.74). EBP colleagues to promote growth and the solving approach to delivering that is infused in most, if not all, of the practice integration of new knowledge into faith incorporates the best evidence from research, provisions. Faith , as a community nursing practice (ANA & non-research studies, quality improvement, specialty nursing practice, encompasses HMA, 2017). and opinions from content experts with the art and science of nursing and spiritual The FCN uses EBP interventions such as patient care data, clinician expertise, and care. The practicing FCN may look to the health counseling, prayer, presence, active patient preferences, beliefs, and values. disciplines of theology, pastoral care or listening, advocacy, referrals, and a wide When delivered in the context of a caring chaplaincy for sources of evidence to guide variety of other resources available to the and supportive practice situation, the highest EBP. Different from ordained or lay ministry, faith community (ANA & HMA, 2017, p.2). quality and best patient and family outcomes FCNs bring to their role all of the meaning Advance Practice Registered Nurses (APRNs) can be achieved. and competencies of their licensed nursing and nurses prepared at the graduate level As cited in Melnyk and Fineout-Overholt heritage. have advanced knowledge, skills, abilities, (2015), Sackett, Straus, Richardson, The FCN demonstrates the following critical thinking, and judgment; and as such, Rosenberg, and Haynes in 2000, defined basic competencies in regards to EBP: have additional advanced FCN competencies. EBP as the contientious use of current best • Verbalizes how research is applied in As FCNs begin evidence-based practice, it practice in making decisions about patient a relevent manner in the healthcare is important to understand the process and care—a definition that is still relevent today. setting and practice; implement the steps one at a time. According Subsequently, the scope of the definition has • poses questions in the practice and to Melnyk and Fineout-Overholt (2015), there broadened to infer a reliable and enduring care delivery setting and identifies the are seven essential and sequential steps of EBP: problem-solving approach that integrates: intersections of health, spirituality, Step 0 cultivates a spirit of inquiry within • A systematic search for, critical and spiritual care where research may an evidence-based culture and environment appraisal of, and synthesis of the best be applied or replicated; Step 1 asks a crucial practice question (see and most relevant research to answer an • uses current and relevant evidence- description of PICOT format below) urgent or crucial clinical question; may based knowledge to guide professional Step 2 requires searching for the best and be referred to as “external evidence”; practice, including research and most relevant practice • The practitioner’s own clinical outcomes from practice; Step 3 involves critical evaluation and expertise, which includes “internal • utilizes evidence when implementing appraisal of the evidence quality and strength evidence” derived from practice, quality nursing practice, process, or behavior Step 4 facilitates integration of the best improvement projects, systematic changes; evidence with the practitioner’s clinical patient assessment, evaluation, and • participates, as appropriate, to expertise and patient preferences/values when use of key available resources to result formulate evidence-based practice making a change in practice or care decisions in preferred patient outcomes; through research and quality Step 5 evluates outcomes following the • Patient preferences, beliefs, and values improvement projects to expand the application of the evidence and subsequent (Melnyk & Fineout-Overholt, 2015). body of knowledge on a topic or practice practice changes or care decisions area; Step 6 involves dissemination of the results • upholds ethical and moral principles of and outcomes of the EBP change (Melnyk & What is the role of the competent FCN in research in their personal professional Fineout-Overholt, 2015, p.10). Evidence-Based Practice? practice and the faith community The FCN, in cultivating a spirit of inquiry, Research conducted at the National nursing practice setting (see also Code should be curious and develop a questioning Institutes of Health (NIH) and academic of Ethics, Provision 7, ANA & HMA, approach toward practice. This creates institutions has established a relationship 2017 pg. 21); excitement and passion about challenging the between spiritual practices and health, which • reviews and evaluates research and status quo, making positive practice change, expands the knowledge base for the specialty evidence-based knowledge, data, and and improving care. PICOT is an acronym

Page 8 PERSPECTIVES Winter 2020 that describes the elements of a good clinical Network™ (HCCN) Faith community nursing, as a question; it stands for: P-Patient/Problem, strives to advance I-Intervention, C-Comparison, O-Outcome, the integration of and T-Time. Writing a good PICOT question spiritual care in health specialty nursing practice, clarifies the issue to be addressed, drives the care through clinical evidence search, and facilitates identifying practice, research, encompasses the art and science the right solution(s). An example of a PICOT and education. question is: “Do congregants who participate Their mission aims of nursing and spiritual care. in a blood pressure (BP) clinic conducted by a to improve patient FCN in their faith community over a six month experience and help period have better hypertension management people facing illness than congregants who only measure their BP and grief find comfort based sources for the provision of spiritual at home or at their physician’s office?” and meaning—meeting them where they are. care. When appraising the evidence, the FCN Second, the Spiritual Care Association (SCA) should look for similarities and differences is the first multidisciplinary international across the body of evidence and use tools to professional membership association Resources evaluate the strength and quality of evidence. for spiritual care providers that offers a Arizona State University College of Nursing Although there are several tools, the Johns comprehensive evidence-based model that and Health Innovation’s Center for the Hopkins Evidence-Based Practice Rating Scales defines, delivers, trains, and tests for the Advancement of Evidence-Based provide an excellent framework to evaluate provision of high-quality spiritual care Practice. https://journals.lww.com/ research and non-research evidence. Once (Hughes, B.P, et al, 2017). In 2019, the Spiritual ajnonline/pages/collectiondetails. the best evidence is identified, the practicing Care Association created a nursing division aspx?TopicalCollectionId=10 (last updated FCN can integrate this with the needs of the to serve FCNs and all nurses striving to 2016). A collection of articles was authored client (patient, congregation, community) provide spiritual care in their nursing practice, by faculty to assist nurses in the step-by- to implement a change in care delivery and/ regardless of practice setting. step implementation of EBP. Also identifies or practice. Goals, objectives, and aims of The primary role of the FCN is to provide resources for continuing education regarding the EBP implementation are defined and intentional care of the spirit and address EBP. the outcomes are evaluated. It is important the needs of their patients—body, mind, Church Health Center (2019 revision). for the results to be disseminated through and spirit—while promoting health and Foundations of Faith Community Nursing publication, presentation, and even informal preventing (or minimizing) disease in the Curriculum: Faculty. Church Health Center: sharing with colleagues in order to contribute context of faith beliefs and traditions and Memphis, TN. to growth of the body of evidence. the larger community (ANA & HMA, 2017). Curators of the University of Missouri This differentiates the specialty practice from (2018). Evidence-based nursing practice: What are the sources of evidence that are that of general registered nursing practice. Using PICO to define clinical questions. relevant to the FCN As such, faith community nursing practice is https://libraryguides.missouri.edu/c. Faith Community Nursing draws from strengthened by the use of multiple evidence- CONTINUED ON PAGE 11 nursing evidence. Additionally, other disciplines are potential sources of evidence from which EBP may be derived. For example, nursing has a long history of focusing on whole-person health and spirituality to alleviate suffering and achieve healing, if not cure. However, nurses may express inadequacy about providing spiritual care, struggle to articulate a functional or actionable definition of spirituality, and may be uncertain about what constitutes spiritual care (Hughes, B.P, et al, 2017). The FCN may find appropriate resources to help them in Chaplaincy. Two prominent organizations offer chaplaincy resources that can be used by the FCN. First, the HealthCare Chaplaincy Caring for the Human Spirit® Magazine PERSPECTIVES Winter 2020 A Newsletter for Spiritual ReadCare this in Nursingbi-annual andpublication, Faith withCommunity content-rich Nursing articles Practice Page 9 for multiple disciplines. For a free subscription: “ The ability to provide www.healthcarechaplaincy.org/magazine primary palliative care is a skill set that nurse practitioners should Spiritual Care Grand Rounds Webinars acquire, develop, Hear experts present on a wide range of spiritual care topics and refine ... Equally every month. CEs/certificate of completion. as important as the For more information: distressing physical www.healthcarechaplaincy.org/education symptoms are issues related to spiritual or emotional distress.” (Journal for Nurse Practitioners. Caring for the Human Spirit Conference 2016;12(10):647-653) May 20-22, 2019, Myrtle Beach, South Carolina

We’re the experts in clinical care, education and research related to spiritual care in health care.

FOR ADDITIONAL RESOURCES: www.spiritualcareassociation.org • www.healthcarechaplaincy.org CONTINUED FROM PAGE 9

php?g=28271&p=174073 Dearholt, S., & Dang, D. (2017). Johns Hopkins Nursing Evidence-based Practice: Models and Guidelines. , International: Indianapolis, IN. A comprehensive resource book to guide nurses when implementing EBP. Health Ministries Association, Inc https:// hmassoc.org/ Sonoma State University Library. (January 19, 2019).Evidence-based practice: Nursing http://libguides.sonoma.edu/c. php?g=202651&p=1336400 Website defines EBP, describes how to compose a PICOT question, identifies search engine resources and scholarly databases to find evidence, and offers tips to appraise evidence strength and quality. HealthCare Chaplaincy Network™ www. healthcarechaplaincy.org Spiritual Care Association (www. spiritualcareassociation.org) The Westberg Institute for Faith Community Nursing (https://westberginstitute.org/) References American Nurses Association & Health Ministries Association, Inc (2012). Faith community nursing: Scope and standards of practice, 2nd Edition. Silver Spring, MD: NurseBooks.org. American Nurses Association & Health Ministries Association, Inc (2017). Faith community nursing: Scope and standards of practice, 3rd Edition. Silver Spring, MD: NurseBooks.org. Hughes, B. P., DeGregory, C., Elk, R., Graham, D., Hall, E. J., & Ressallat, J. (March 2017). Spiritual Care and Nursing: A Nurse’s Contribution and Practice. White Paper. HealthCare Chaplaincy Network. Melnyk, B. M. & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice, 3rd Edition. Philadelphia: Lippincott Williams & Wilkins.

Written by Mary Lynne Knighten, DNP, RN, NEA-BC with contributions from Deborah Ringen, MSN, RN-BC Faith Community Nurse; Marcia Potter, RN, MS Arts; and the staff of the Westberg Institute for Faith Community Nursing, Church Health (Memphis, TN), August 22, 2019.

PERSPECTIVES Winter 2020 A Newsletter for Spiritual Care in Nursing and Faith Community Nursing Practice Page 11