There is little doubt that evidence-based principles have changed the way we think about clinical practice. However, there are challenges to clinical decision making that evidence alone cannot answer. Challenges include realities such as research populations not reflecting “real-world” application, inconsistent adherence to evidence-based principles within clinical practices, sophisticated decision rules overshadowing clinical experience, and gaps in care that impact outcomes. This article attempts first to demonstrate caveats of using and interpreting evidence-based principles and, second, to illustrate common evidence-based concepts which many clinicians misunderstand. These include the cascade effect, common risk difference measures, and predictive values.

Knowledge development is critical for the enhancement of evidence-based nursing practice and the overall delivery of care to obtain superior clinical outcomes. Nursing scholars have built on Carper’s (1975, 1978) fundamental patterns of knowing to improve nursing practice over the last 40 years and is still used today. Doctor of nursing practice (DNP) professionals should understand the various patterns of knowledge development and the implications provided for transforming health care models and systems in the clinical setting.

Background: Patients undergoing noncardiac surgery can experience cardiac complications, which are a major cause of morbidity and mortality in the perioperative period. The goal of this quality improvement (QI) project was to standardize the preoperative assessment process and improve patient-centered care by implementing evidence-based practice guidelines for electrocardiogram (ECG) recommendations prior to noncardiac surgery. Methods: Three steps were used to implement the American College of Cardiology/American Heart Association (ACC/AHA) recommendation for ECG to reduce variance in practice and decrease surgical cancellations. A pre- and postdesign was used to evaluate 2 outcomes: decreased surgical cancellations for lack of a current ECG and surgical loss opportunity cost. All data were retrospectively collected for 60 days during the pre- and postperiods. Results: Evidence-based, preoperative ECG recommendations were implemented in the electronic medical record (EMR). Overall, ECG guideline adherence increased from 50% to 66% (χ² = 2.19, p = .139) postimplementation. Surgical cancellations because of unmet ECG requirements were reduced from 50% to 34% (χ² = 2.19, p = .139) post-EMR guideline implementation. There was no statistical difference in the cost associated with loss surgical opportunity minutes between the periods (t = 0.79, p = .43, 95% CI [−6.96, 16.24]). Discussion: We successfully implemented an evidence-based guideline recommending specific preoperative ECG requirements within a busy Veterans Administration hospital. This project stimulated ongoing dialogue between the disciplines with positive trends in decreased surgical cancellations.

A strong relationship exists between theory, research, and evidence-based practice; and these three entities are necessary to guide practice and contribute to the body of nursing knowledge. Doctor of nursing practice graduates can serve as leaders as they enter into their respective clinical practice areas. Through education of peers, along with translation and evaluation of current theoretical literature and empirical data, these advanced practice nurses can positively influence nursing practice and patient care.

This article discusses student-prepared poster presentations as an educational tool. The poster presentation exercise is often the beginning of in-depth study, which can ultimately lead to mastery of a particular clinical topic, a presentation at a professional meeting, and/or a publication in a professional journal. As a teaching and educational tool, the poster presentation exercise in advanced practice nursing education provides an opportunity for interactive, experiential learning through the process of “learning by doing,” which unifies personal clinical experience with empirical data and didactic course material.

For this quality improvement (QI) project, the desired outcomes were the reduction of the incidences of withheld neuraxial analgesia (NA) for healthy parturients and the adoption of evidence-based practice (EBP) by the anesthesia providers (APs). The practice change was designed using the diffusion of innovations in health service organizations change model. The 3 interventions used to achieve the outcomes of the project were (a) revision of the anesthesia service’s standard operating procedure (SOP) to incorporate recent recommendations addressing platelet count limits for parturients, (b) addition of a clinical decision reminder in the patient’s electronic medical record (EMR), and (c) educating obstetrical APs about the new SOP and updated EMR.

Outcomes were measured using pre- and postimplementation surveys of the staff who work on the labor and delivery ward to evaluate AP practice variance and a modified EBP Implementation Scale to measure the adoption of the evidence by the APs. The QI project was successful in reducing practice variance and resulted in fewer incidences of withheld NA for healthy parturients, and 57.1% of the APs reported changing their practice by adopting the evidence for this project.