La enfermera de práctica avanzada en unidades de hospitalización como facilitadora de prácticas basadas en la evidencia

Abstract

Introduction. The incorporation of Evidence-Based Clinical Practice (EBCP) into daily decision-making of registered nurses continues to be a challenge for the health system. Contributing factors are usually related to the organizational culture, the characteristics of the professional or those intrinsic to the evidence itself. All this increases the variability in clinical practice since many times decision-making is based solely on the experience and judgment of the nurse. The incorporation of advanced practice nurses is a strategy used by many health systems for various purposes since they can reduce the variability in clinical practice and therefore improve clinical results. The present study implements a complex intervention, based on proven effective theories so that the incorporation of this figure in hospitalization units is a success in improving implementation and improving good practices. Aim. To evaluate the inclusion of an Advanced Practice Hospitalization Nurse (APHN) into hospitalization units as a facilitator of the EBCP by registered nurses. Methods. A quasi-experimental study was developed in which the clinical indicators derived from two clinical practice guidelines (CPG) that measured the nursing care process in units with and without the presence of APHN were compared. Likewise, the conditions of the work environments were evaluated with the PES-NWI instrument, as well as the attitudes, skills and perceptions of clinical nurses in EBCP through the use of the HS-EBP instrument. The study also measured the competency development of the APHN with the IECEPA instrument and identified the implementation strategies used to achieve a change in clinical practice. The i-PARIHS framework and the Theory of Planned Behavior (TPB) were used as theoretical frameworks that guided the planning, execution, and evaluation of the proposed intervention. Results. An increase in adherence to the recommendations of both CPG was observed in the units with APHN. The perception of the work environment and the EBCP of the APHN group has improved in a statistically significant way, as well as their level of competence in advanced practice. 13 strategies and 52 behavior change techniques used in the implementation process were identified. The main activities have been aimed at increasing the knowledge and skills of registered nurses about the CPG, mentoring and support in decision-making, feedback on results, promoting a critical spirit in their own practice and teamwork. Conclusions. The incorporation of APHN to hospital units has shown a clear improvement in the adoption of EBCP, which has translated into an improvement in clinical indicators of patient care. The focus on two CPG illustrates the potential benefits of this figure in terms of implementing evidence and promoting adherence to the CPG among other members of the nursing team. The difference in perception between professionals who practice in different categories shows a tendency to value more favorably the items that measure the PES-NWI and HS-EBP instruments as responsibility within the organization increases. The good results in the clinical indicators are the product of a real process of behavior change of registered nurses towards EBCP, that has been facilitated by the APHN, through a structured and effective intervention that has implied the use of a set of methods and TPB-based behavior change techniques and different implementation strategies.