Developing the infrastructure to support EBP: it takes a library.

In the inaugural EBP column, Levin and Feldman (2006) cited an article by Pravikoff, Tanner, and Pierce (2005) that listed nurses' perceptions of the five top-ranked barriers to using an EBP approach to practice (after not having sufficient time) as follows: * Not valuing the contribution that research can make to practice * Lack of understanding of how to use electronic databases * Difficulty in obtaining evidence (information) * Lack of computer skills * Difficulty understanding research articles A recent editorial in Worldviews on Evidence-Based Nursing poses the following question: "Should we invest time in teaching critical appraisal skills to nurses? Or, should we simply provide nurses with pre-appraised research evidence?" (Bucknall & Hutchinson, 2006, p. 137). The authors of this editorial reiterate the findings above about nurses' perceptions of being overwhelmed by the tasks associated with finding, retrieving, appraising, and synthesizing evidence for best practices. Another critical question then becomes this: If we teach nurses all the skills they need to use an evidence-based approach to practice, what infrastructure do clinical agencies provide for helping to access and obtain the latest and best evidence on a clinical problem? I would like to share recent experiences I have had working with agencies to facilitate EBP integration in an attempt to flesh out the issues and challenges involved in accessing and retrieving information (i.e., the best available evidence). First, the Visiting Nurse Service of New York is in the forefront of implementing an evidence-based approach to nursing practice. Examples of these initiatives demonstrate the agency's commitment to this effort: * Partnering with Pace University to conduct a pilot study to test the effectiveness of introducing an EBP mentoring model on nurse, system, and patient outcomes * Supporting an EBP education day for nurses in the Quality Management Department * Hiring a visiting faculty member half time who is an expert (this author) in EBP in the Department of Education and Clinical Development * Developing a mentoring program for selected nurse managers to help them learn and implement EBP in their respective divisions 1 * Integration of EBP into the internship curriculum for new baccalaureate degree nursing graduates who wish to work in a home health care setting as a first nursing position As described in the literature, a major challenge the agency is now facing is difficulty in accessing the needed evidence on which to make evidence-based clinical decisions. Although the Quality Management Department has included a subscription to EBSCOhost 2 in the current year's budget, nurses are finding that access to needed information is still a problem. Access to full-text articles is limited, and no mechanisms are in place for interlibrary loan access or for health sciences librarian services to assist with searching for and negotiating retrieval of evidence. This has become particularly challenging because as nurses are adopting an EBP approach to practice, they are sharing their difficulties in accessing the needed information for the EBP projects they wish to pursue. Second, during the pilot study mentioned above (Levin, Vetter, Fineout-Overholt, Melnyk, & Barnes, 2007) funded through a grant to Pace University Lienhard School of Nursing by the Hugoton Foundation, an EBP mentor (this author) engaged nurses in learning about the EBP process and implementing it by developing an innovative practice based on the best available evidence. The project director, a Pace University professor who also served as the EBP mentor, was able to arrange for access by study participants to the university's electronic library. The library administrator agreed to provide a special identification number and password to study participants but not access to interlibrary loan. …