NURS 716 Week 7 Discussion Board Forum 4 on Sustaining Evidence-Based Practice Changes Example

Discussion Board Forum 4: Implementing and Sustaining Evidence-Based Practice

NURS 716 Applications of Evidence-Based Care, Discussion Board Forum 4

Thread by [Student Name]

The hospital, the earlier project and the people replied to are composites written for a model discussion.

Three years ago, our surgical services department launched a structured hand-off bundle between the operating room and the post-anesthesia care unit. It was well designed, the nurse who led it was respected, and audits showed nearly complete use within four months. A year later she moved to another hospital. Within six months, the bundle form had disappeared from most charts, new staff had never heard of it, and our hand-off complaints returned. Nothing about the evidence had changed. What changed was that the person holding the practice together had left.

That experience shapes how I am planning the prophylactic dressing project. Melnyk and Fineout-Overholt (2015) describe implementation as a process that continues after a change is introduced, requiring ongoing evaluation and support, and the revised Iowa Model separates the decision to adopt a practice from the work of integrating and sustaining it. Sustainability is not the last step of a project; it is a property that has to be designed in from the first.

Research on sustainment supports this. Lai et al. (2026) surveyed 319 nurses taking part in evidence-based practice in China and interviewed 15, grouping their experience by how long a practice had been in routine use, from not yet routine to more than five years, and then sorted what helped and hindered against the 48 constructs of an implementation framework widely used in nursing. Their approach shows that the factors that matter shift over time, so a plan built only for launch will miss what keeps a practice alive in its second or third year. A teaching article in a series on evidence-based decision-making for DNP students makes the practical point that the implementation plan itself should be designed for success and sustainability, rather than treating sustainment as a separate phase (Zonsius et al., 2025).

For the dressing project, I am making four design choices now. First, the practice will be owned by a role, the perioperative charge nurse on each shift, rather than by me. Second, dressing application will be embedded in the surgical safety checklist and the intraoperative record, so its absence is visible. Third, dressings will be added to every relevant preference card and stocked through standard par levels, so supply does not depend on anyone remembering. Fourth, pressure injury rates for long cases will be added to the department's existing monthly quality dashboard, so monitoring continues after my project ends. If a practice still depends on its champion a year after launch, it has been adopted but not yet sustained. Jesus warned about building on sand rather than rock (English Standard Version Bible, 2001/2016, Matthew 7:24-27); a practice built on one person's energy is built on sand.

Reply to the Instructor

Dr. Morgan, you asked how a department can grow its own champions so that a practice survives turnover. A long-running program offers a model. Hayakawa et al. (2026) describe an evidence-based practice scholars program in a pediatric health system that has run since 2007, enrolling 147 nurses and graduating 124 through a seven-month structured curriculum. Participants' evidence-based practice knowledge increased by an average of 15.7%, and scholar-led projects produced more than 40 policy updates, new care guidelines and quality improvements, along with posters and presentations. A program like that creates a pool of nurses who can inherit a practice when its original leader moves on. A smaller fellowship evaluated at another organization tracked retention of fellows and changes in evidence-based practice culture alongside costs, which suggests such programs can be justified on more than one ground (Shever-Doletzky et al., 2026). For our department, even two scholars a year would mean that the dressing practice has more than one person who understands its evidence and can explain it to new staff. I plan to recommend that the project budget include protected time for one perioperative nurse to train as a second champion during the pilot. That nurse would co-lead the monthly review of dressing use and could take over completely if I leave the department.

Reply to Hannah

Hannah, your venous thromboembolism prophylaxis project faces the same risk I described: strong results at launch and slow drift afterward. A recent study speaks directly to that drift. Xie et al. (2026) interviewed staff in a neurosurgery department about barriers to sustaining an evidence-based program for preventing deep vein thrombosis in patients with aneurysmal subarachnoid hemorrhage, after their earlier research had shown the program reduced thrombosis. They used the Consolidated Framework for Implementation Research to organize what made sustained, high-fidelity use difficult in routine care. A similar framework-guided approach was used with operating room nurses to understand barriers to pressure injury prevention (Gao et al., 2026). The lesson for your project is that you could interview a few nurses at six months, using the same framework, to find out which elements are drifting before the outcome data show it. Process data tell you about drift months before thrombosis rates do, because a missed prophylaxis dose shows up in an audit the same week, while a thrombosis may not appear for months. Would your unit's practice council be willing to repeat a short fidelity audit every quarter after you graduate?

Reply to Marcus

Marcus, I agree with your point that education alone does not sustain change, and I would push it further: education may be the weakest sustainment strategy, because it leaves with the people who received it. Zonsius et al. (2025) emphasize designing the implementation plan for sustainability from the outset, which in practice means using strategies that outlast individual staff, such as changes to records, order sets and policies. The revised Iowa Model also treats integration into practice as its own step, separate from the pilot, which signals that a change must become part of the system rather than remain a project (Iowa Model Collaborative, 2017). In your sepsis screening project, that might mean building the screen into the triage documentation rather than relying on a reminder card, and assigning its monitoring to the emergency department's quality nurse rather than to yourself. Proverbs warns that a person who does not tend his vineyard finds it overgrown with thorns (English Standard Version Bible, 2001/2016, Proverbs 24:30-31), and practices need tending too, by structures that do not depend on memory. It may also help to set an expiration date for review, a point at which the practice council must decide whether to keep, revise or retire the screen, so that it neither fades quietly nor continues without evidence. Which part of your screen could be built into the record before you leave the project?

References

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Gao, Y., Chen, J., Guang, W., Xu, W., Wei, Z., & Yang, H. (2026). A qualitative study of facilitators and barriers to intraoperative acquired pressure injury prevention implementation in operating room nurses based on the CFIR framework. Frontiers in Health Services, 6, Article 1877556. https://doi.org/10.3389/frhs.2026.1877556

Hayakawa, J., Bowden, V., & Schuhler, P. (2026). Building and sustaining evidence-based practice through a scholars program. Worldviews on Evidence-Based Nursing, 23(1), Article e70109. https://doi.org/10.1111/wvn.70109

Iowa Model Collaborative. (2017). Iowa Model of Evidence-Based Practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223

Lai, J., Zhang, Y., Chi, J., Miao, J., Lin, H., Luo, W., Fu, J., Deng, S., Guo, Z., Zhong, C., Tang, J., Guo, B., Yang, T., & Wu, Y. (2026). Perceptions of factors associated with sustainability of evidence-based nursing practice: A sequential mixed methods study. Journal of Nursing Management, 2026(1), Article e6680206. https://doi.org/10.1155/jonm/6680206

Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-based practice in nursing and healthcare: A guide to best practice (3rd ed.). Wolters Kluwer.

Shever-Doletzky, L. L., Edick, P., Tschannen, D. J., Taylor, N., & Wenzel, L. (2026). The impacts of a practicing nurse evidence-based practice fellowship program on clinicians, patients, culture, and cost. Worldviews on Evidence-Based Nursing, 23(3), Article e70144. https://doi.org/10.1111/wvn.70144

Xie, W., Zhang, Y., Liu, D., Gong, Y., Li, H., Cao, M., & Zhang, C. (2026). Exploring barriers to the sustainable implementation of an evidence-based program for preventing deep vein thrombosis in patients with aneurysmal subarachnoid hemorrhage: A qualitative study using the Consolidated Framework for Implementation Research (CFIR). BMC Health Services Research, 26(1), Article 248. https://doi.org/10.1186/s12913-026-14063-7

Zonsius, M. C., Milner, K. A., Farus-Brown, S., & Fineout-Overholt, E. (2025). Designing the implementation plan for success and sustainability. American Journal of Nursing, 125(12), 46-54. https://doi.org/10.1097/AJN.0000000000000203