Shed old ways, be innovative in patient care, nurses told

ORLANDO––The evidence shows we can do better.

Bernadette Mazurek Melnyk, PhD, CPNP/PMHNP, FAANP, the keynote speaker at the American Nephrology Nurses’ Association’s 46^th National Symposium held here last week, opened with a challenge to attendees to “capture your dream.”

For the past 30 years, Dr. Melnyk’s dream has been to have nursing care be based on evidence. It’s time to draw a line through the statement “because we have always done it that way” and replace it with, “In God we trust, everyone else bring data,” she told attendees. She has worked tirelessly to promote this and provided an overview of the current state of U.S. health care, health, and evidenced-based practice (EBP) in nursing.

The cost of misguided care

Poor quality health care costs the United States $720 billion annually, yet patients receive only 55% of the care that they should, said Dr. Melnyk. The cost would be reduced by 30% if EBP was the foundation of our health care, she said, not only for patients we serve but also for ourselves. Nurses at Ohio State University, for example, have become “nurse athletes” to help curb unhealthy behaviors and improve health among nurses.

Some easy steps

Cardiac risk increases 30% if one sits more than three hours each day. Dr. Melnyk suggests that we stand at meetings; they would go faster as well as promote healthier behavior. A video clip she showed during her talk, titled “What will your last 10 years look like” reminds us that choices we make today influence our health and wellness outcomes later on.

Often a crisis instills the impetus for change.

The following healthy living behaviors will reduce diabetes by 66%, heart disease by 45%, and stress by 93%:

Physical activity – 30 minutes, five days a week.
Healthy eating – five fruits and vegetables per day
No smoking
Alcohol in moderation – one drink per day for women and two drinks per day for men

The science of EBP, merged within a context of caring, yields the best results. Evidence gives us the confidence to act. Dr. Melnyk finds that nursing research tends to be warm and fuzzy; we must strive for high-impact, hard outcomes to realize change, such as the influence of different treatment approaches and length-of-stay on cost. She described one of her studies that reduced the length of stay in the neonatal intensive care unit by four days and resulted in a savings of $500 per infant.

Dr. Melnyk surveyed U.S. nurses on the value of EBP and found that highly educated nurses were clearer on the steps needed to incorporate evidence into their practice, while more seasoned nurses felt EBP was less important. It is critical to evoke a culture of EBP in order to develop and sustain it. Many magnet hospitals are losing their status because they haven’t instilled the culture to sustain EBP. Her survey of chief nursing officers from 276 hospitals shows that 15% have devoted no funds from their annual operating budgets to building and maintaining EBP.

Reduce your risk with evidence-based decisions

She closed her session with the statement, “Ask yourself what would you do tomorrow and in the next two to three years, if you knew that you could not fail.” An evidence-based answer has the best chance of success. -by Sheila M. Deziel, MSN, RN, CNN

Resources for EBP

- Worldviews on Evidence-Based Nursing (2014)

http://onlinelibrary.wiley.com/journal/10.1111(ISSN)1741-6787/homepage/MostCited.html

- Evidence-Based Practice, Step by Step: A 10-part Series

http://www.nursingcenter.com/evidencebasedpracticenetwork/Home/Tools-Resources/Collections/AJN-EBP-Series.aspx