Impact of Evidence-Based Practice and Next Big Ideas
Following the influential Crossing the Quality Chasm report (IOM, 2001), experts emphasized that the preparation of health professionals was crucial to bridging the chasm (IOM, 2003). The Health Professions Education report (IOM, 2003) declared that current educational programs do not adequately prepare nurses, physicians, pharmacists or other health professionals to provide the highest quality and safest health care possible. The conclusion was that education for all health professions were in need of "a major overhaul" to prepare health professions with new skills to assume new roles (IOM, 2003). This overhaul would require changing way that health professionals are educated, in both academic and practice settings. Programs for basic preparation of health professionals were to undergo curriculum revision in order to focus on evidence-based quality improvement processes. Also, professional development programs would need to become widely available to update skills of those professionals who were already in practice. Leaders in all health disciplines were urged to come together in an effort for clinical education reform that addresses five core competencies essential in bridging the quality chasm: All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice, quality improvement approaches, and informatics (IOM, 2003). Table 4 presents details of each competency.
From this core set, IOM urged each profession to develop details and strategies for integrating these new competencies into education. With a focus on employing evidence-based practice, nurses established national consensus on competencies for EBP in nursing in 2004 and extended these in 2009 (Stevens, 2009). The ACE Star Model served as a framework for identifying specific skills requisite to employing EBP in a clinical role. Through multiple iterations, an expert panel generated, validated, and endorsed competency statements to guide education programs at the basic (associate and undergraduate), intermediate (masters), and doctoral (advanced) levels in nursing. Between 10 and 32 specific competencies are enumerated for each of four levels of nursing education which were published in Essential Competencies for EBP in Nursing (Stevens, 2009). These competencies address fundamental skills of knowledge management, accountability for scientific basis of nursing practice; organizational and policy change; and development of scientific underpinnings for EBP (Stevens, 2009).
A measurement instrument was developed from these competencies, called the ACE EBP Readiness Inventory (ACE-ERI). The ACE-ERI quantifies the individual's confidence in performing EBP competencies. The ACE-ERI exhibits strong psychometric properties (reliability, validity, and sensitivity) and is widely used in clinical and education settings to assess nurses' readiness for employing EBP and measuring impact of professional development programs (Stevens, Puga, & Low, 2012). The ACE Star Model, competencies, and ERI have been adopted into practice settings as nurses strategize to employ EBP. These resources have also been incorporated into educational settings as programs are revised to include EBP skills.
Curricular efforts were also underway. To stimulate curricular reform and faculty development, the IOM suggested that oversight processes (such as accreditation) be used to encourage adoption of the five core competencies. Initiatives that followed included the new program standards established by the American Association of Colleges of Nursing, crossing undergraduate, masters, and doctoral levels of education (AACN, 2013). The AACN standards underscored the necessity for nurses to focus on the systems of care as well on the evidence for clinical decisions. This systems thinking is crucial to effect the changes that are part of employing EBP.
Another curricular initiative became known as Quality and Safety Education in Nursing Institute (QSEN) (QSEN Institute, 2013). Through multiple phases, this project developed a website that serves as a central repository of information on core QSEN competencies, knowledge, skill, attitudes, teaching strategies, and faculty development resources designed to prepare nurses to engage in quality and safety.
Educating nurses in EBP competencies was catapulted forward with the publication of Teaching IOM (Finkleman & Kenner, 2006). While the materials presented were in existence in other professional literature, the book added great value by synthesizing what was known into one publication. This resource was accessible to every faculty member offering teaching strategies and learning resources for incorporating the IOM competencies into curricula across the nation. The resource continues to be updated and expanded through subsequent editions and versions (Finkleman & Kenner, 2013a; 2013b). The strength of these resources is that the approaches and strategies remain closely aligned with the Institute of Medicine's continuing progress toward better health care. This close alignment reflects the appreciation that nursing must be part of this solution to effect the desired changes; and remaining in the mainstream with other health professions rather than splintering providers into discipline-centric paradigms.
Impact on Nursing Education
Following the influential Crossing the Quality Chasm report (IOM, 2001), experts emphasized that the preparation of health professionals was crucial to bridging the chasm (IOM, 2003). The Health Professions Education report (IOM, 2003) declared that current educational programs do not adequately prepare nurses, physicians, pharmacists or other health professionals to provide the highest quality and safest health care possible. The conclusion was that education for all health professions were in need of "a major overhaul" to prepare health professions with new skills to assume new roles (IOM, 2003). This overhaul would require changing way that health professionals are educated, in both academic and practice settings. Programs for basic preparation of health professionals were to undergo curriculum revision in order to focus on evidence-based quality improvement processes. Also, professional development programs would need to become widely available to update skills of those professionals who were already in practice. Leaders in all health disciplines were urged to come together in an effort for clinical education reform that addresses five core competencies essential in bridging the quality chasm: All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice, quality improvement approaches, and informatics (IOM, 2003). Table 4 presents details of each competency.
From this core set, IOM urged each profession to develop details and strategies for integrating these new competencies into education. With a focus on employing evidence-based practice, nurses established national consensus on competencies for EBP in nursing in 2004 and extended these in 2009 (Stevens, 2009). The ACE Star Model served as a framework for identifying specific skills requisite to employing EBP in a clinical role. Through multiple iterations, an expert panel generated, validated, and endorsed competency statements to guide education programs at the basic (associate and undergraduate), intermediate (masters), and doctoral (advanced) levels in nursing. Between 10 and 32 specific competencies are enumerated for each of four levels of nursing education which were published in Essential Competencies for EBP in Nursing (Stevens, 2009). These competencies address fundamental skills of knowledge management, accountability for scientific basis of nursing practice; organizational and policy change; and development of scientific underpinnings for EBP (Stevens, 2009).
A measurement instrument was developed from these competencies, called the ACE EBP Readiness Inventory (ACE-ERI). The ACE-ERI quantifies the individual's confidence in performing EBP competencies. The ACE-ERI exhibits strong psychometric properties (reliability, validity, and sensitivity) and is widely used in clinical and education settings to assess nurses' readiness for employing EBP and measuring impact of professional development programs (Stevens, Puga, & Low, 2012). The ACE Star Model, competencies, and ERI have been adopted into practice settings as nurses strategize to employ EBP. These resources have also been incorporated into educational settings as programs are revised to include EBP skills.
Curricular efforts were also underway. To stimulate curricular reform and faculty development, the IOM suggested that oversight processes (such as accreditation) be used to encourage adoption of the five core competencies. Initiatives that followed included the new program standards established by the American Association of Colleges of Nursing, crossing undergraduate, masters, and doctoral levels of education (AACN, 2013). The AACN standards underscored the necessity for nurses to focus on the systems of care as well on the evidence for clinical decisions. This systems thinking is crucial to effect the changes that are part of employing EBP.
Another curricular initiative became known as Quality and Safety Education in Nursing Institute (QSEN) (QSEN Institute, 2013). Through multiple phases, this project developed a website that serves as a central repository of information on core QSEN competencies, knowledge, skill, attitudes, teaching strategies, and faculty development resources designed to prepare nurses to engage in quality and safety.
Educating nurses in EBP competencies was catapulted forward with the publication of Teaching IOM (Finkleman & Kenner, 2006). While the materials presented were in existence in other professional literature, the book added great value by synthesizing what was known into one publication. This resource was accessible to every faculty member offering teaching strategies and learning resources for incorporating the IOM competencies into curricula across the nation. The resource continues to be updated and expanded through subsequent editions and versions (Finkleman & Kenner, 2013a; 2013b). The strength of these resources is that the approaches and strategies remain closely aligned with the Institute of Medicine's continuing progress toward better health care. This close alignment reflects the appreciation that nursing must be part of this solution to effect the desired changes; and remaining in the mainstream with other health professions rather than splintering providers into discipline-centric paradigms.
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