Implementing the new essential evidence-based practice competencies in real-world clinical and academic settings: moving from evidence to action in improving healthcare quality and patient outcomes.

It has been a little over a year since the first set of essential evidence-based practice (EBP) competencies for practicing nurses and advanced practice nurses (APNs) were published in Worldviews on Evidence-Based Nursing (Melnyk, GallagherFord, Long, & Fineout-Overholt, 2014). In the initial year after publication, there were over 13,000 downloads of this paper, which indicates the great interest worldwide in these new competencies. However, dissemination of evidence alone, including these competencies, does not typically result in changes in real-world practice and academic settings. Dissemination of evidence must be taken a step further by acting upon the evidence that is published to make changes to improve health care and health outcomes. Now that there is a landmark set of research-based, essential EBP competencies for practicing registered nurses and APNs, we must take action to implement them in the real world to ultimately improve healthcare quality and patient outcomes as well as to reduce costs. Competence is often described broadly as a concept that incorporates knowledge, skills and attitudes, and the ability to do something well (Ilic, 2009; Melnyk et al., 2014). A variety of health professions have used competencies as a mechanism to determine whether clinicians are providing high-quality safe care (Gallagher-Ford, Buck, & Melnyk, 2014; Williams et al., 2010). As an example in the nursing profession, the Quality and Safety Education for Nurses (QSEN) Project is a global initiative that developed six competencies for nursing education to prepare students with the knowledge, skills, and attitudes to improve quality and safety. The QSEN competencies include: (a) patient-centered care, (b) teamwork and collaboration, (c) EBP, (d) quality improvement, (e) safety, and (f) informatics. Other healthcare disciplines, such as medicine, have developed and implemented competencies, such as essential geriatrics competencies for internal medicine and family medicine, developed in 2010 through a consensus-building process that included leadership and members of key stakeholder organizations. There are very few validated tools that exist to measure competency in EBP. The three tools that do exist, the Berlin questionnaire, the Fresno tool, and the Assessing Competency in Evidence based medicine (ACE) tool, have focused on medical students and graduates from medical school (Ilic, 2009). The Berlin tool is a 15-item, self-report knowledge assessment tool that was created to measure EBP knowledge in medical professionals (Fritsche, Greenhalgh, Falck-Ytter, Neumayer, & Kunz, 2002). However, a major limitation is that the Berlin tool only assesses step 3 in the EBP process (i.e., critical appraisal of evidence; Ilic, 2009). The Fresno assessment tool also was developed to measure medical professionals’ EBP competence, specifically knowledge and skills in EBP (Ramos, Schafer, & Tracz, 2003). The Fresno tool is a standardized objective measure of EBP, which is comprised of two clinical scenarios with open-ended questions that tap four steps in the EBP process to which participants respond. The ACE tool is a 15-item assessment of EBP competency, including knowledge, attitudes, skills and behaviors (Ilic, Nordin, Glasziou, Tilson, & Villanueva, 2014). It contains a short patient scenario from which a clinical question is presented followed with a search strategy and a hypothetical article extract. Participants taking the ACE assessment answer 15 “yes” or “no” questions that represent four steps of EBP, including forming the clinical question, searching the literature, critical appraisal, and application of the evidence to the patient (Ilic et al., 2014). Items 1 through 11 on the ACE tool assess EBP knowledge and skills, and items 12 to 15 assess attitudes toward implementing EBP in the clinical setting. As these three tools were developed specifically to measure EBP competence in the medical profession, there is a tremendous need to develop additional valid and reliable tools that are applicable to other professions, including practicing nurses and APNs. Now that the new EBP competencies for practicing nurses and APNs exist, there is a tremendous window of opportunity to develop an objective valid and reliable assessment based on these competencies.