The value of nursing practice based on research is widely accepted. However, incorporating and executing a practice based on science is easier said than done. There are many competing variables to instituting a practice change, and each organization has its own culture and variables (Institute of Medicine, 1996).
The idea of instituting evidence-based practice (EBP) across the Department of Defense's Military Health Care System (MHCS) was the unique idea of several doctoral-prepared nurse researchers who held key positions within the MHCS. Under the leadership of Lt. Col. Duong (in this supplement), the initiative was developed and launched. I assumed the role of principal investigator on the Research to Practice EBP project in 2003. I continued the work of my predecessor and ensured that the nurses attended EBP educational programs with Dr. Marita Tilter (in this supplement). After completing the educational programs, the nurses developed, with my guidance, their EBP projects and received funding for the projects. Each project had (a) a proposal and budget, (b) timeline, and (c) short, intermediate, and long-term goals. Every EBP project was evaluated, and the practice was adjusted based upon the evidence.
This supplement highlights a few of the multiple projects these ambitious military and Department of Defense nurses have undertaken. I wish to commend them all for their Herculean efforts. Preparing the EBP projects for publication required expert writing skills. We are grateful for Carol Parsons' participation in editing the articles and providing encouragement to the authors while they finalized their articles and continued with their regular responsibilities. Her contributions and steady support were appreciated by everyone.
I would like to highlight a few unique areas of healthcare practice within the MHCS. First, on average, 33% of military nurses are transferred annually, and they are often deployed to war zones. For this reason, institutional memory for nursing care rests with the civilian Department of Defense nurses. Therefore, it was imperative to have buy-in from all nurses for EBP to become incorporated into the institution's culture and for it to become the way of doing business. Second, the patient population of active-duty service members and their families transfer frequently. Because of the transient nature of the patient population, tracking data were difficult in some situations, although electronic medical records have improved the availability of data. On average, it took 30-36 months to institutionalize practice changes due to shifts in staffing, obtaining buy-in from administration, reviewing by human research ethics (if required), piloting and implementing practice changes, and reevaluating the practice changes.
I am pleased that despite our ups and downs EBP is well on its way to being institutionalized within the MHCS.
Patricia W. Kelley, PhD, RN
Uniformed Services University
[email protected]
Reference