Evidence-based practice (EBP) is an important part of providing sound, even excellent, patient care from the nursing perspective. As a nurse, I have come to realize that what we do goes far beyond the scope of assessment, diagnosis, planning, implementation, and evaluation of interventions and outcomes of patient systems and their responses to their various experienced environments. Nurses have the privilege and responsibility to be innovators and researchers for the benefit of their patients as well, ever vigilant for better and safer practices that provide positive outcomes. However, it is not enough for a nurse to research and implement change for the patients that they come into direct contact with; nurses must also be aware of the significance of their research findings on a larger scale and be champions of change for all patients within the institutions where they find employment. The evidence-based practice course not only emphasized the importance of this evolving role of the nurse, but also provided guidance in how to go about implementing these changes even when faced with cultural barriers to EBP.

     For our group project, we decided to develop a program at Ocala Regional Medical Center, to be implemented in theory at this time, directed to provide support for the families of Traumatic Brain Injury (TBI) survivors. While I became interested in TBIs from my experiences working in the ICU, I was really never aware of the difficulties that group of patients face re-entering society as thriving, “normal” individuals. It was only after having done research during the B.S.N. program that I really uncovered the extent of the difficulties TBI survivors face and how critical it was to their recovery, and prosperity following recovery, that they have strong support from their families. The evidence we uncovered when looking into this situation revealed that often times the emotional impact that this transformative disease process plays on the patient and family can be devastating and eventually take its toll people struggle to understand what has happened to their family member. Unfortunately, however, while outreach programs for TBI patients and families have been demonstrated to have positive outcomes for all parties who benefit; follow-ups do not appear to be the normal protocol following discharge.

     Recognizing the need for follow-up and outreach to TBI patients is what inspired me and my group to engage in the development of a hospital-based community outreach and follow-up program for the patients and families of TBI survivors. In its essence, the TBI outreach program is primarily geared towards family support. First, we wanted early teaching of the many potential effects of a TBI to family while at bedside as a nurse-driven protocol. Before discharge to home, recruitment to the program would include gaining reliable contact information and setting up a free Skype© account for the family to use during designated times of the week. All program contact information would be included on a discharge pamphlet that the primary caregivers could keep in a secure location at home. Also before discharge, a first contact appointment would be made to be performed by either Skype© or telephone depending on preference. We would follow-up for the first time in a week and then routinely at a month, 3 months, 6 months, 9 months, and on the year anniversary of discharge. While providing follow-up and outreach was beneficial, we also wanted the program to be accessible on a prn basis during times of crisis at home.

     We hoped that the program would be mostly self-sustaining through volunteerism rewarded with points towards the clinical ladder. Unfortunately, we realized relying solely on volunteers to provide outreach was an unrealistic goal. We therefore decided that it would be critical to the success of the program to assign a nurse to be dedicated to coordinating volunteer and patient scheduling, nurse education and competencies, and overall maintenance of the program. This nurse would need to be an expert clinician with experience caring for TBI patients and with excellent people and communication skills. The position created to coordinate the various aspects of the program would be the most expensive part of this program, but could be justified by evidence supporting increased positive outcomes through the community.

     The Evidence-Based Practice (EBP) curriculum was a final critical piece of our B.S.N. education because it asked us to take research findings and find practical applications for them in the clinical setting. More important than this however, the EBP course placed the emphasis on how we should be conducting ourselves in the clinical setting. It helped me realize that we can no longer allow be burdened by a nursing culture that does things just because “that’s the way we’ve always done it”. It is critical for ourselves and our patients that nurses think outside of the box and ask the clinical questions that will lead us to improve our patients’ care. Knowing how to perform research and how to use EBP are just two more tools in the professionally trained nurse’s toolbox that help us to build our profession up so that we are seen as the vital part of healthcare that we know we are. But we must not be afraid to try and use the tools at our disposal or we risk them becoming rusty and dull. The people who seek care and are provided it by nurses deserve the best possible chance they have at making a complete recovery. As a part of an interdisciplinary team of professional health care providers, we have a responsibility to them that our part in their care is given with excellence, but in order to do that we have to basing our clinical decisions on sound evidence.