Healthcare is in a constant state of change. Clinical agencies need to quickly adapt as knowledge of treatments, interventions, and technology evolve. Healthcare organizations strive to integrate the most current evidence-based practice (EBP) into their clinical policies. However, a large barrier to the implementation of this research is available time and funding.1
Creating a partnership between academic and clinical agencies is a successful solution to the barriers of EBP utilization.2,3 These long-term partnerships benefit both parties involved by strategically enhancing their unique skills toward a united goal. First, clinical agencies identify aspects of care they want improved. Then, they involve undergraduate students in the investigation. The students complete an EBP project, gaining research experience, and the clinical agencies receive the results without exceeding budgets.
Team creation
Building a partnership between clinical and academic agencies requires facility commitment, delegation, and communication. Outreach for a dedicated partnership can be initiated by the clinical agency or the university.
Clinical agencies promote their commitment to the partnership by looking for opportunities for undergraduate assistance. The clinical agency should be highly invested in its project outcomes to encourage adequate clinical participation. Strong participation by a clinical agency facilitator involves coordinating meetings, providing resources, and updating the university on significant clinical changes.
Academic agencies commit to the partnership by requesting to be involved in research. The research team should understand the clinical goals for the project and the amount of assistance needed from the facility. The research team needs to be dedicated to the clinical agency and identify as a part of the care team.
Before the partnership is finalized, a specific leadership team should be identified to allow for streamlined delegation. The leadership team may include a clinical faculty member, preferably with a background in research development and EBP implementation; an academic faculty member involved in research studies; and undergraduate students at varying academic levels with an interest in evidence-based research.
The clinical agency team decides on the project they deem appropriate and presents it to the academic agency. The academic leader then informs the students of the project details and projected outcomes. Upon students' acceptance, a student leader is chosen to organize the undergraduate meetings. The student team encompasses various education levels, including sophomores, juniors, and seniors. The student leader should have at least 1 year until graduation, conducted supervised research for a minimum of 1 year, and participated in a particular research project for one semester.
The team's dedication to communication is necessary to ensure its success. It's vital that the clinical agency dedicates time to the project. Although the students conduct the research, the clinical agency facilitator needs to be available for project clarification and guidance. Students meet approximately once a week to discuss and share findings. The student leader reports to the academic leader three times per month. The academic leaders and clinical facilitators correspond often to ensure that both agencies are at the same progress point. To enhance direct communication, a facility should select an academic institution that's close in proximity. This allows for greater personal interaction between team members and reduces travel time and cost.
Partnership maintenance
When a project is completed, a new project should be introduced. Without a project that results in constant communication, the partnership may dissipate. With the introduction of a new project, the undergraduate team should rapidly outline course plans to maintain momentum. It's the clinical agency's obligation to establish a new project and the academic agency's responsibility to conduct it.
The timeline from establishment to evaluation for EBP projects often takes years; therefore, new students need to be continually recruited for research to compensate for students lost to graduation. Students employed during their sophomore year have time to learn the process of EBP research. This experience enhances students' skills and presents an opportunity to become potential leaders. A team should recruit semiannually to employ new members to continue ongoing projects.
Pilot project
For the past 2 years, a small Mid-Western hospital and the University of Wisconsin-Eau Claire nursing program have been working together on EBP projects for hospital utilization. The project chosen focused on increasing staff education to reduce readmission rates for heart failure (HF) patients. The team included a doctor of nursing practice faculty member with a background in administration, a clinical nurse specialist educator at the hospital, a nursing student team leader, and an interdisciplinary group of two students.
Two meetings were conducted with the clinical faculty member, academic faculty member, and the student leader to determine the best method to achieve the clinical outcome. After discussion, the partnership decided to conduct new knowledge discussion groups with a focus on current literature and education. Students initiated the project by conducting a literature review for EBP articles related to HF education.
Articles were chosen by their relevance to the enhancement of staff education for HF patients. Each article was peer reviewed, published within the last 3 years, and found using the search terms "heart failure," "education," "staff education," "patient communication," and "readmission rates." The team decided on four articles that discussed various aspects of patient HF education. Each article was used for one meeting to ensure a dynamic discussion as suggested by the guidelines used.4
The discussion was located in the hospital orientation room. The room was chosen based on its amenities. It was conveniently located near bathrooms and provided a quiet environment in a central location familiar to all staff. The room also included a round table to facilitate group conversation. Meetings were held once a month to allow the academic team to prepare. Each discussion had two sessions to allow nurses on various shifts to attend. The hospital approved the time spent at the discussions as ongoing education credit for RN licensing. This was created as an incentive for nurse attendance. Hospital management also marketed the project through e-mail, flyers, and word of mouth.
Copies of each article were available via e-mail for participants to read in preparation for the meeting. At each meeting, the clinical agency also printed the article for the next discussion so that participants received a hard copy. The student facilitators began the 1-hour discussions by briefly introducing themselves along with background information regarding the project. A prepared outline served as a discussion guide and the student facilitators prompted the participating RNs with a question concerning the aforementioned material. Students were careful not to use language that suggested they believed themselves to be experts on EBP.
The discussion was designed to accomplish learning through literature while RNs became familiar with practices on specific units. The literature refreshed RN staff on patient engagement methods during periods of education. Common themes arose among the topics discussed, including ideas with the potential for implementation and further investigation.
Themes that emerged during discussion included, but weren't limited to:
* "A major obstacle for patient education is the lack of time available for nursing staff to complete instruction."
* "Nurses need a strong patient relationship to make education meaningful and memorable."
* "Efficient assessment of a patient's ability to comprehend information includes patient readiness for education, identification of potential barriers to compliance, and preferred learning style."
* "Report of patient hand-off should include covered educational material."
* "Informal caregivers present during patient education empower patients to effectively manage their illness."
* "Nurses should evaluate the most appropriate situation for education."
* "Nurses should use meaningful teaching skills, including teach-back, visual aids, written material, and therapeutic conversation."
After each discussion, participants filled out a short, anonymous survey regarding the article choice, facilitation of the discussion, overall environment, personal expectations, and any additional comments or suggestions. Feedback revealed the RNs were very receptive to the project and benefited from the discussion.
The future plan for this project includes replication of this process with new EBP articles. Themes discussed by the nurses possess the potential for unit implementation and can be brought to clinical management for further consideration. The pilot process may also be adapted for a different project and repeated within the facility.
Final evaluation of the project also identified possible changes to the advertising process. The number of participants was limited even though efforts to encourage attendance were in place. In collaboration with the clinical agency, new plans are underway to increase staff participation. Increasing attendance is a priority goal for future clinical and academic partnerships.
Student experiences
Undergraduate students benefited from the pilot project as evidenced by personal reflection. They felt honored to be involved with a project that incorporated problem solving, research, clinical integration, and evaluation. The students felt that they had advanced their own careers through skills they obtained during the project. The undergraduate students developed a stronger understanding of teamwork; through collaboration, they discovered how to combine ideas and verbalize their personal interpretations. The partnership also provided them with an opportunity for professional networking with clinical staff. The staff members who attended the meetings had more academic and clinical experience than the students facilitating the discussion, so students learned to effectively and confidently communicate with professionals.
Research is utilized in the undergraduate curriculum; however, this type of project helps solidify the importance of research in practice. Students involved in the pilot program expanded their research horizon and learned to conduct literature reviews, utilize search engines, and categorize articles. After an article was chosen, students broke down the article and wrote a concurrent outline. They formalized questions that followed the article and prompted discussion.
The appointed student leader also obtained valuable experience in management and communication. The specific role of the leader required the delegation and oversight of research activities. The student leader also organized weekly meetings with team members to discuss previous meetings, new research discovered, and faculty suggestions.
The multiple skills obtained during the pilot project serve as an important addition to the students' personal development. Students involved were able to use this project on their resume and found their employers to be impressed with their research experience. Being involved in clinical research can be an asset to undergraduate students for future practice and education.
A win-win scenario
Healthcare practice and policy require constant maintenance to provide high-quality care. Implementation of EBP absorbs a facility's valuable time and money. Creating a partnership between clinical and academic agencies can overcome these barriers and benefit patients, students, clinical and academic staff, and the overall organization.
Partnerships are created through a strategic plan, including specific team members, organized meetings, effective communication, and united goals. Maintenance is required to keep the partnership intact. This occurs through two main goals: diligent correspondence between team members and ongoing student recruitment through the university.
Clinical and academic partnerships afford clinical agencies time and talent to complete EBP projects and undergraduate students the opportunity to complete relevant research, participate in professional communication, and be vital members of the healthcare team. Clinical and academic partnerships have the potential to change the way that healthcare systems implement EBP by bringing innovative and enlightening opportunities to young scholars.
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