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What is Evidence-Based Practice in Nursing?

5 min read • June, 01 2023

Evidence-based practice in nursing involves providing holistic, quality care based on the most up-to-date research and knowledge rather than traditional methods, advice from colleagues, or personal beliefs.

Nurses can expand their knowledge and improve their clinical practice experience by collecting, processing, and implementing research findings. Evidence-based practice focuses on what's at the heart of nursing — your patient. Learn what evidence-based practice in nursing is, why it's essential, and how to incorporate it into your daily patient care.

How to Use Evidence-Based Practice in Nursing

Evidence-based practice requires you to review and assess the latest research. The knowledge gained from evidence-based research in nursing may indicate changing a standard nursing care policy in your practice Discuss your findings with your nurse manager and team before implementation. Once you've gained their support and ensured compliance with your facility's policies and procedures, merge nursing implementations based on this information with your patient's values to provide the most effective care.

You may already be using evidence-based nursing practices without knowing it. Research findings support a significant percentage of nursing practices, and ongoing studies anticipate this will continue to increase.

Evidence-Based Practice in Nursing Examples

There are various examples of evidence-based practice in nursing, such as:

Use of oxygen to help with hypoxia and organ failure in patients with COPD
Management of angina
Protocols regarding alarm fatigue
Recognition of a family member's influence on a patient's presentation of symptoms
Noninvasive measurement of blood pressure in children

Improving patient care begins by asking how you can make it a safer, more compassionate, and personal experience.

Learn about pertinent evidence-based practice information on our Clinical Practice Material page .

Five Steps to Implement Evidence-Based Practice in Nursing

A young female nurse is seated at a desk, wearing a light blue scrub outfit and doing research using a laptop and taking notes.

Evidence-based nursing draws upon critical reasoning and judgment skills developed through experience and training. You can practice evidence-based nursing interventions by following five crucial steps that serve as guidelines for making patient care decisions. This process includes incorporating the best external evidence, your clinical expertise, and the patient's values and expectations.

Ask a clear question about the patient's issue and determine an ultimate goal, such as improving a procedure to help their specific condition.
Acquire the best evidence by searching relevant clinical articles from legitimate sources.
Appraise the resources gathered to determine if the information is valid, of optimal quality compared to the evidence levels, and relevant for the patient.
Apply the evidence to clinical practice by making decisions based on your nursing expertise and the new information.
Assess outcomes to determine if the treatment was effective and should be considered for other patients.

Analyzing Evidence-Based Research Levels

You can compare current professional and clinical practices with new research outcomes when evaluating evidence-based research. But how do you know what's considered the best information?

Use critical thinking skills and consider levels of evidence to establish the reliability of the information when you analyze evidence-based research. These levels can help you determine how much emphasis to place on a study, report, or clinical practice guideline when making decisions about patient care.

The Levels of Evidence-Based Practice

Four primary levels of evidence come into play when you're making clinical decisions.

Level A acquires evidence from randomized, controlled trials and is considered the most reliable.
Level B evidence is obtained from quality-designed control trials without randomization.
Level C typically gets implemented when there is limited information about a condition and acquires evidence from a consensus viewpoint or expert opinion.
Level ML (multi-level) is usually applied to complex cases and gets its evidence from more than one of the other levels.

Why Is Evidence-Based Practice in Nursing Essential?

Three people are standing in a hospital corridor, a male nurse and two female nurses, and they are all looking intently at some information that one of the nurses is holding in her hands.

Implementing evidence-based practice in nursing bridges the theory-to-practice gap and delivers innovative patient care using the most current health care findings. The topic of evidence-based practice will likely come up throughout your nursing career. Its origins trace back to Florence Nightingale. This iconic founder of modern nursing gathered data and conclusions regarding the relationship between unsanitary conditions and failing health. Its application remains essential today.

Other Benefits of Evidence-Based Practice in Nursing

Besides keeping health care practices relevant and current, evidence-based practice in nursing offers a range of other benefits to you and your patients:

Promotes positive patient outcomes
Reduces health care costs by preventing complications
Contributes to the growth of the science of nursing
Allows for incorporation of new technologies into health care practice
Increases nurse autonomy and confidence in decision-making
Ensures relevancy of nursing practice with new interventions and care protocols
Provides scientifically supported research to help make well-informed decisions
Fosters shared decision-making with patients in care planning
Enhances critical thinking
Encourages lifelong learning

When you use the principles of evidence-based practice in nursing to make decisions about your patient's care, it results in better outcomes, higher satisfaction, and reduced costs. Implementing this method promotes lifelong learning and lets you strive for continuous quality improvement in your clinical care and nursing practice to achieve nursing excellence .

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Anne Mulhall , MSc, PhD
Independent Training and Research Consultant West Cottage, Hook Hill Lane Woking, Surrey GU22 0PT, UK

https://doi.org/10.1136/ebn.1.1.4

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Why has research-based practice become so important and why is everyone talking about evidence-based health care? But most importantly, how is nursing best placed to maximise the benefits which evidence-based care can bring?

Part of the difficulty is that although nurses perceive research positively, 2 they either cannot access the information, or cannot judge the value of the studies which they find. 3 This journal has evolved as a direct response to the dilemma of practitioners who want to use research, but are thwarted by overwhelming clinical demands, an ever burgeoning research literature, and for many, a lack of skills in critical appraisal. Evidence-Based Nursing should therefore be exceptionally useful, and its target audience of practitioners is a refreshing move in the right direction. The worlds of researchers and practitioners have been separated by seemingly impenetrable barriers for too long. 4

Tiptoeing in the wake of the movement for evidence-based medicine, however, we must ensure that evidence-based nursing attends to what is important for nursing. Part of the difficulty that practitioners face relates to the ambiguity which research, and particularly “scientific” research, has within nursing. Ambiguous, because we need to be clear as to what nursing is, and what nurses do before we can identify the types of evidence needed to improve the effectiveness of patient care. Then we can explore the type of questions which practitioners need answers to and what sort of research …

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Nursing Research

Nursing research worldwide is committed to rigorous scientific inquiry that provides a significant body of knowledge to advance nursing practice, shape health policy, and impact the health of people in all countries. The vision for nursing research is driven by the profession's mandate to society to optimize the health and well-being of populations (American Nurses Association, 2003; International Council of Nurses, 1999). Nurse researchers bring a holistic perspective to studying individuals, families, and communities involving a biobehavioral, interdisciplinary, and translational approach to science. The priorities for nursing research reflect nursing's commitment to the promotion of health and healthy lifestyles, the advancement of quality and excellence in health care, and the critical importance of basing professional nursing practice on research.

As one of the world leaders in nursing research, it is important to delineate the position of the academic leaders in the U.S. on research advancement and facilitation, as signified by the membership of the American Association of Colleges of Nursing (AACN). In order to enhance the science of the discipline and facilitate nursing research, several factors need to be understood separately and in interaction: the vision and importance of nursing research as a scientific basis for the health of the public; the scope of nursing research; the cultural environment and workforce required for cutting edge and high-impact nursing research; the importance of a research intensive environment for faculty and students; and the challenges and opportunities impacting the research mission of the discipline and profession.

Approved by AACN Membership: October 26, 1998 Revisions Approved by the Membership: March 15, 1999 and March 13, 2006

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Critical thinking in nursing clinical practice, education and research: From attitudes to virtue

Affiliations.

1 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group Quantitative Psychology (2017-SGR-269), University of Barcelona, Barcelona, Spain.
2 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, Consolidated Research Group on Gender, Identity and Diversity (2017-SGR-1091), University of Barcelona, Barcelona, Spain.
3 Department of Fundamental Care and Medical Surgital Nursing, Faculty of Medicine and Health Sciences, School of Nursing, University of Barcelona, Barcelona, Spain.
4 Multidisciplinary Nursing Research Group, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Hospital, Barcelona, Spain.
PMID: 33029860
DOI: 10.1111/nup.12332

Critical thinking is a complex, dynamic process formed by attitudes and strategic skills, with the aim of achieving a specific goal or objective. The attitudes, including the critical thinking attitudes, constitute an important part of the idea of good care, of the good professional. It could be said that they become a virtue of the nursing profession. In this context, the ethics of virtue is a theoretical framework that becomes essential for analyse the critical thinking concept in nursing care and nursing science. Because the ethics of virtue consider how cultivating virtues are necessary to understand and justify the decisions and guide the actions. Based on selective analysis of the descriptive and empirical literature that addresses conceptual review of critical thinking, we conducted an analysis of this topic in the settings of clinical practice, training and research from the virtue ethical framework. Following JBI critical appraisal checklist for text and opinion papers, we argue the need for critical thinking as an essential element for true excellence in care and that it should be encouraged among professionals. The importance of developing critical thinking skills in education is well substantiated; however, greater efforts are required to implement educational strategies directed at developing critical thinking in students and professionals undergoing training, along with measures that demonstrate their success. Lastly, we show that critical thinking constitutes a fundamental component in the research process, and can improve research competencies in nursing. We conclude that future research and actions must go further in the search for new evidence and open new horizons, to ensure a positive effect on clinical practice, patient health, student education and the growth of nursing science.

Keywords: critical thinking; critical thinking attitudes; nurse education; nursing care; nursing research.

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New Research in Nursing - Education and Practice

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Discover cutting-edge research and novel approaches in nursing education and practice in this comprehensive collection. This book offers an overview of the latest advancements in nursing. All authors received global acclaim for the relevance of their research for clinical interventions and the discovery of the transformative potential of the integration of new technology in clinical practice. This book explores the challenges and opportunities faced by healthcare professionals in today's complex global healthcare environment. The authors clearly emphasize the role of education in shaping nursing practice for developing the next generation of nursing providers since the quality of clinical competences has a powerful impact on therapeutic progression and recovery from illness. This book presents a comprehensive overview of clinical research and education that aims to help healthcare providers give their patients the best treatments for different metabolic and psychiatric diseases. Whether you are a patient, student, or experienced professional seeking to expand your knowledge, this volume is a valuable resource. It provides a state-of-the-art review of different aspects of nursing research and education and is recommended for everyone who is focused on the care of patients, their families, and their communities.

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The Importance of Nursing Research

Nursing research has a tremendous influence on current and future professional nursing practice, thus rendering it an essential component of the educational process. This article chronicles the learning experiences of two undergraduate nursing students who were provided with the opportunity to become team members in a study funded by the National Institute of Nursing Research. The application process, the various learning opportunities and responsibilities performed by the students, and the benefits and outcomes of the experience are described. The authors hope that by sharing their learning experiences, more students will be given similar opportunities using the strategies presented in this article. Nursing research is critical to the nursing profession and is necessary for continuing advancements that promote optimal nursing care.

Throughout the 21st century, the role of nurse has evolved significantly. Nurses work in a variety of settings, including the hospital, the classroom, the community health department, the business sector, home health care, and the laboratory. Although each role carries different responsibilities, the primary goal of a professional nurse remains the same: to be the client's advocate and provide optimal care on the basis of evidence obtained through research.

Baccalaureate programs in the United States prepare students for entry-level nursing positions. The focus is to care for individuals throughout the human life span. Knowledge is acquired from textbooks, classroom and Web-based instruction, simulation, and clinical experiences. The goal of all programs is for students to graduate as safe, entry-level professionals, having received a well-rounded exposure to the nursing field. Students are exposed to evidence-based nursing practice throughout their curriculum; however, the allocated time for nursing research is often limited. Many programs require only one 3-credit hour course for nursing research. This amount of time is limited, despite the broad spectrum of nursing research and its influence on current and future nursing care.

Research is typically not among the traditional responsibilities of an entry-level nurse. Many nurses are involved in either direct patient care or administrative aspects of health care. Nursing research is a growing field in which individuals within the profession can contribute a variety of skills and experiences to the science of nursing care. There are frequent misconceptions as to what nursing research is. Some individuals do not even know how to begin to define nursing research. According to Polit and Beck (2006) , nursing research is:

systematic inquiry designed to develop knowledge about issues of importance to nurses, including nursing practice, nursing education, and nursing administration. (p. 4)

Nursing research is vital to the practice of professional nursing, and the importance of its inclusion during undergraduate instruction cannot be overemphasized. Only with exposure and experience can students begin to understand the concept and importance of nursing research.

The purpose of this article is to describe undergraduate students’ experiences of becoming aware of and participating in a federally funded research study from the National Institute of Nursing Research. As a part of funding for the study, which was an AREA award ( A cademic R esearch E nhancement A ward, R15 mechanism), there were designated opportunities for student involvement. The primary aim of the research study was to investigate the effects of gene-environment interactions on risk factors of preclinical cardiovascular disease in a cohort of 585 young adults who all had a positive family history of cardiovascular disease (i.e., essential hypertension or premature myocardial infarction at age 55 or younger in one or both biological parents or in one or more grandparents), verified in the medical record. Specific genes examined included cytochrome P-450, family 1, subfamily A, polypeptide 1; cytochrome P-450 2A; glutathione S-transferase mu 1; and glutathione S-transferase theta 1. Cardiovascular-dependent measures were diastolic blood pressure, endothelium-dependent arterial vasodilation, left ventricular mass indexed for body size, systolic blood pressure, and total peripheral resistance. The effects of ethnicity and gender were also explored.

Learning Opportunity

The learning process began with the principal investigator (M.S.T.) of the study visiting the junior class (class of 2007) of baccalaureate students at the Medical College of Georgia. This particular student group was chosen due to their academic standing because they would have the chance to take full advantage of learning directly from a nurse researcher for one full year before graduation. The principal investigator briefly presented and discussed the growing field of nursing research, the advancements made by nursing research, and the critical role of nursing research to nursing practice. The principal investigator also presented an overview of the funded research study and extended an invitation to students to apply for two part-time positions on the grant that were designed specifically for nursing student involvement. Students recognized the excellent opportunity and were intrigued with the future possibilities. They understood this option was unique and appeared to be a great pathway for becoming an active participant in learning the nursing research process through involvement in an official nursing research study.

The principal investigator established objective criteria for the application process. The criteria included writing a maximum 1-page essay sharing the reasons why the students wanted to join the research project as a team member and also sharing their personal and professional goals for involvement in the study. Many students were interested; thus, it was a very competitive process. The principal investigator reviewed the essays and selected approximately 10 prospective individuals for an interview. The interview was an extension of the essay. At the interview, the principal investigator further described the positions, provided a detailed overview of the grant, and had the opportunity to gain a better understanding of the student candidates. The students were encouraged to ask questions to further understand the expectations of the prospective opportunity. The interview also provided the students with increased exposure to the study's goal and more familiarization with the expectations of the funded positions.

After the interview process was completed, two individuals were selected, per the grant specifications. The selected individuals described the interview process as a positive experience that helped solidify their desire to become involved in the research study. The principal investigator emphasized that this job opportunity was designed to be a learning experience in which the students would be guided through the entire research study process and become members of a multidisciplinary team. Time responsibilities for each student included approximately 6 hours per week. The principal investigator communicated clearly that the nursing baccalaureate program was the first priority for the students, and thus provided a flexible work schedule.

Research Study Experience

The students began working in early april 2006. The first step in the work experience included 6 weeks of funded orientation. This was their first exposure to the research process; thus, it was important for the students to be provided with a strong foundation. Orientation included attending a team meeting and being introduced to the members of the multidisciplinary team (i.e., biostatistician, cardiologist, geneticists, nurse researcher, and psychologist, all of whom served as co-investigators, and the genetic laboratory personnel); reviewing the grant application; completing the Collaborative Institutional Training Initiative (CITI) (2000) ; completing the Roche educational program on genetics; and touring the worksite facilities. Reviewing the grant gave the students a better understanding of the specific aims and objectives of the study and the intended procedures of the genetic laboratory work in which the students would be involved. The complexity of the grant required the principal investigator to further explain and clarify specific details. The CITI training, which is required by the institution's Office of Human Research Protection, was completed online and took approximately 5.5 hours. The CITI program was presented in a tutorial format, and satisfactory completion of numerous quizzes was required. The task was tedious and time consuming, but valuable and essential, as it increased the awareness of the established codes of conduct for research. At the conclusion of the CITI training, the students understood the necessary policies and procedures for maintaining security and confidentiality of human subjects, the legal and ethical issues regarding the research process, and the essential procedures for research conduct.

Although the students had a basic understanding of genetics, they completed the Roche Genetics Education Program (2004) to gain a deeper understanding. The program was direct and easy to navigate and was excellent for all learning styles, as it contained both visual and auditory explanations. The explanations covered both basic and complex genetic concepts. Through the use of the genetics program, the students were able to comprehend abstract genetic details and to further understand the importance and influence of genetics on personal health. To conclude the orientation process, students were taught basic laboratory procedures, such as polymerase chain reaction and restrictive enzyme digestion, which were used to perform genotyping for the study. After these procedures had been observed several times, the students were given the opportunity to acquire hands-on experience with these laboratory techniques. Each of these components of the orientation process provided the students with the needed foundation for becoming involved in the research study.

After approximately 2 months of orientation, the students were ready to begin working in the genetics laboratory. One of the primary responsibilities of the students would be to further learn and become confident with genotyping techniques. The laboratory was shared among research personnel of several funded studies, with various research experiments being conducted concurrently. The students, under the supervision of the principal investigator and geneticist (H.Z.), also worked with experienced research assistants to perform the genotyping. The students maintained a daily log describing the laboratory genotyping procedures and experiments, and these logs were reviewed at team meetings. Although the actual procedure for polymerase chain reaction seemed straightforward, the students quickly learned that quality control must be used. Sometimes during genotyping, the DNA samples did not produce results. The students discovered that there are numerous contributing factors to successful polymerase chain reaction, such as quality of DNA templates, primer specifications, temperature settings, gel conditions, pipette measuring accuracy, and general laboratory techniques. Even the slightest error could result in permanent DNA sample loss, major experiment failure, or DNA sample contamination.

The students met with the research team members frequently to discuss and troubleshoot potential solutions and problem solve techniques that would foster improving the success rate and productivity of the genotyping. From the laboratory experience, the students learned that every detail must be considered and addressed precisely and meticulously when conducting experiments. Sometimes the process became frustrating, but the students soon discovered that patience and persistence were the most important attributes for a laboratory researcher to possess. The laboratory experience was an excellent hands-on learning opportunity. The students no longer viewed research as strictly information gathered from a journal or textbook, but rather as a physical act that required extreme concentration, dedication, and determination.

After spending numerous months in the laboratory performing the required genotyping, the students had the opportunity to be exposed to another role of a nurse researcher. They performed literature reviews regarding the study. Although the students had written papers in their nursing school program that required literature citations, they were not familiar with all of the library resources available to them. In no time, the students learned which library and online resources had the most validity and what would be the most relevant to their study. The literature search results provided the students and principal investigator with information on new studies that had been conducted on gene-environment interactions regarding tobacco smoke exposure and cardiovascular disease. From the literature review experience, the students learned the importance of being selective and time efficient. Often when a search was first begun, thousands of articles were listed, but the students learned the importance of narrowing the searches to the specific areas of focus. After the students completed their searches, they met with the principal investigator, who provided direction on the articles identified as the most relevant to the study.

The students continued working with the principal investigator during data review, analysis, and preparation of dissemination of the results (i.e., the publishing process). They helped to prepare an abstract submission of the study presented at an international meeting ( Tingen et al., 2007 ). They also helped with the preparation of manuscripts of the study results. By the conclusion of their work experience, the students will have been exposed to and participated in the entire research process.

Benefits and Outcomes

From the students’ perspectives, this opportunity was extremely beneficial. Prior to this experience, the students were not familiar with nursing research. Their original perception of research was that it was conducted by people with chemistry, biology, biochemistry, and genetic degrees in laboratories at major universities. They now realize that nursing and research can be combined and that optimal nursing care is dependent on the latest research findings. In addition, the students believe this opportunity has been beneficial in learning that nurse researchers are valuable to nurses in other settings. For example, one of the long-term goals of this research study is to develop appropriate interventions for children who are more susceptible to and at risk for the harmful effects of tobacco smoke due to their genetic heritage. The information obtained by a nurse researcher can be disseminated to nurses who work directly with the individuals to whom the research applies. Practice that has shown to be effective through research allows nurses to better advocate for patients and provide the best possible care. Although the majority of nurses who provide patient care will be consumers of nursing research, implementing evidence-based nursing practice is crucial to provide optimal nursing care. Information from nursing research has the potential to directly impact the care provided to patients in all health care settings.

Now that the students have had the opportunity to become more familiar with nursing research through involvement as team members, they recognize that their future professional possibilities are endless. Nursing research is an emerging and growing field in which individuals can apply their nursing education to discover new advancements that promote evidence-based care. They learned the research process and the important roles that each team member plays during the study phases of conception, design, implementation, analysis, and dissemination. Each aspect of the research process is important and contributes to the overall success of the study.

The students also discovered the benefit of trying new things. Prior to this experience, they had little exposure to the research process and nursing research. Consequently, they had to be receptive to learning and recognize that acquiring new knowledge was a gradual process. At times, the students felt anxious because all aspects were new, but they realized that without trying, they would never advance and feel comfortable with the research process. As the students reflected, they thought this was an excellent growing experience professionally, scholastically, and personally. In addition, this opportunity benefited the students’ peers through discussions and their sharing of work responsibilities, the research process, and the importance of evidence-based practice. As future nurses, the students are strong proponents of nursing research, and this experience has also broadened their horizons regarding future professional growth and opportunities. In addition, they have a better understanding of the importance of scientific evidence to support their clinical practice. As a result, the students thought that a stronger emphasis should be placed on nursing research in undergraduate baccalaureate education and that more students should have the opportunity to participate as team members in nursing research studies.

The students were almost one full year into nursing school and thought they had learned about all of the possibilities for their futures when they were first presented with this learning opportunity. They knew their future options were numerous and included working in acute care and community settings. They also realized they could further their education and pursue graduate degrees to include a master's degree and become an administrator, educator, clinical nurse specialist, nurse anesthetist, or nurse practitioner, or potentially pursue a doctorate. They did not know there was an emerging and growing field in which their nursing education could be applied and furthered—the area of research and the role of becoming a nurse researcher. Prior to this experience, students perceived their possibilities for a professional career in nursing were tremendous. Now by being involved in the entire process of conducting a federally funded research study, they realized their future professional possibilities are limitless.

The authors of this paper hope that by sharing their experience, they will encourage both nursing faculty and nursing students to not only introduce the research process into the nursing curriculum, but also to consider making nursing research a tangible and more integrated process. They think that a more beneficial approach to the introduction of research may be achieved through incorporating research-related content into each nursing course throughout the educational process. This could be conducted in addition to the current curriculum plan of many schools of nursing that require a single and concentrated 3-hour research course with a goal of research becoming a positive experience for students that is enthusiastically received as a new learning opportunity. In addition, students who are involved as team members in a funded research study may be provided with scheduled classroom opportunities for making progress reports to their peers. Also, the students could field questions regarding the research project and their experiences. These activities may foster increased learning and interest about research among the students’ classmates.

As nursing students are the future members of the nursing profession, and for the profession to continue to advance, nursing research must be the foundation of comprehensive, evidence-based clinical practice. This may only occur with increased exposure to nursing research. Therefore, it is critical that the future members of the nursing profession be exposed to, develop an appreciation for, and become more involved in nursing research, and thus incorporate its outcomes into the delivery of optimal professional nursing practice.

Acknowledgments

The lead author was awarded a grant (NR008871) from the National Institutes of Health, National Institute of Nursing Research.

Collaborative Institutional Training Initiative [April 14, 2006]; Office of Human Research Protection. The Medical College of Georgia. 2000 from http://www.mcg.edu/Research/ohrp/training/citi.html .
Polit DF, Beck CT. Essentials of nursing research: Methods, appraisal, and utilization. 6th ed. Lippincott Williams & Wilkins; Philadelphia: 2006. [ Google Scholar ]
Roche Genetics Education Program [May 10, 2006]; Education. 2004 from http://www.roche.com/research_and_development_r_d_overview/education.htm .
Tingen MS, Ludwig DA, Dong Y, Zhu H, Andrews JO, Burnett AH, et al. Tobacco smoke exposure and genetics: Youth at risk for cardiovascular disease.. Proceedings of the 13th Annual Meeting of the Society for Research on Nicotine and Tobacco.2007. p. 39. [ Google Scholar ]

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Upcoming Nursing Trends for 2024

12 trends in nursing, 1. job growth for nursing, 2. nurse practitioners on the rise, 3. home healthcare is increasingly popular , 4. the government will regulate nursing home staffing, 5. nurses may earn more, 6. ai will influence nursing education and healthcare, 7. retaining the nursing workforce, 8. increase in training and higher education demand, 9. nurses are increasingly pursuing specializations, 10. hiring bonuses are becoming more common, 11. more male nurses are joining the workforce, 12. telehealth services are on the rise, the bottom line: how do these trends impact students, curriculum and training, skill development, interprofessional education, career preparedness, licensure and certification, research and evidence-based practice, health and wellness focus, global health and diversity, mcphs can help you prepare for the future, related blogs.

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Exploring evidence-based practice research

Chrisman, Jolinda ASN, RN; Jordan, Rita MSN, RN; Davis, Charlotte BSN, RN, CCRN; Williams, Wanda MSN, APRN

Jolinda Chrisman is a MICU Clinical Nurse at the VA Medical Center in Nashville, Tenn. Rita Jordan is a GEC Nurse Educator at VA Tennessee Valley Healthcare System in Murfreesboro, Tenn. Charlotte Davis is a CCU/CVICU Clinical Nurse at Heritage Medical Center in Shelbyville, Tenn., and a Clinical Nurse/Charge Nurse/CCRN Review Program Coordinator at Alvin C. York VA Medical Center in Murfreesboro, Tenn. She is also a Nursing made Incredibly Easy! Editorial Advisory Board Member. Wanda Williams is a Nurse Practitioner at Alvin C. York VA Medical Center in Murfreesboro, Tenn.

The authors have disclosed that they have no financial relationships related to this article.

Evidence-based practice (EBP) is the process of collecting, processing, and implementing research findings to improve clinical practice, the work environment, or patient outcomes. According to the American Nurses Association (ANA), nursing interventions should be practical, methodical decisions based on EBP research studies. Utilizing the EBP approach to nursing practice helps us provide the highest quality and most cost-efficient patient care possible. Here we'll discuss the key characteristics of EBP relating to nursing research.

It's a trend!

Involving all disciplines, EBP is an approach to clinical practice that's been gaining ground since its formal introduction in 1992. Starting in medicine, it then spread to other fields, such as nursing, psychology, and education. Currently, 55% of all nursing practices are based on research findings. The ANA predicts that by 2020, 90% of all nursing practice will be based on EBP research findings.

When you incorporate up-to-date information from new EBP research, you'll be able to question current practices. You may ask questions such as, “Are my current nursing interventions the most effective or safest for my patients?” or “Could we utilize these new EBP interventions in my work area?” Nurses committed to EBP will compare current professional and clinical practices with new research facts and outcomes as they emerge.

To meet the 2020 goal, nurses must become proficient in evaluating various types of EBP research because they provide effective, proven rationales for nursing actions (see Learn the lingo! ). As you incorporate this new knowledge into your clinical practice and work areas, you become a role model and a positive change agent. Share these discoveries with your healthcare team to improve the essential components of your role and work environment.

Knowing where to look

Nurses can find EBP research published in scholarly single-blind or double-blind peer-reviewed journals. Many state and national nursing organizations, such as the ANA, conduct nursing research. The National Institute of Nursing Research is well-known for comprehensive research studies that build the scientific foundation of our nursing practices; enhance hospice and palliative care; and help guide the prevention, treatment, and innovative management of diseases.

Many universities, colleges, and formal nursing programs also conduct and publish research findings in their newsletters or scholarly journals, or on their websites. Remember to look for the latest research findings relevant to your job role.

Consider obtaining appropriate institutional approval and conducting a formal research project of your own if you identify areas for improvement within your job role or work environment (see Caution: permission required ). EBP research can be conducted in any area of nursing, including hospice care, geriatric or long-term care settings, in-patient hospital units, home care, substance abuse programs, and risk management. Besides improving patient outcomes and the work environment, research can help you evaluate social interactions, improve patient safety, resolve environmental issues affecting health, enhance quality of life, develop theories, explore healthcare economic issues, and address benchmarking needs or barriers.

Four key elements

When evaluating EBP nursing research studies, focus on these four criteria:

validity —the legitimacy, accuracy, and soundness of all aspects of the study
reliability —the extent to which a measurement's result is consistent
relevance —the logical connection between two ideas, tasks, or events
outcome —the conclusions reached through the process of research.

If a study's outcome doesn't demonstrate validity, reliability, or relevance, using it to make a change in current practices that have a proven history of effectiveness, efficiency, and positive outcomes may not be justified. But if the study's outcome is valid, reliable, and relevant to your work environment or patient population, you should consider incorporating the new information into current clinical practice. Failure to utilize EBP to guide nursing care increases the risk of poor outcomes.

The dynamic duo

Quantitative and qualitative research are the two types of EBP research that nurses perform, evaluate, and utilize to guide nursing interventions and improve patient care (see Quantitative versus qualitative research ). Research can be specifically quantitative or qualitative, or a combination of both. When a research project utilized both quantitative and qualitative data, it's commonly called a mixed–methods research study.

Three types of quantitative research

Quantitative research consists of information expressed in numbers, variables, and percentages. It seeks to confirm that all problems, dilemmas, or hypotheses have clear, concrete, and objective solutions that can be expressed in a numerical format. This type of research focuses on specific, narrow questions in a double-blind study, usually with a large random group and variables. The data collected can be analyzed with the help of statistics in an unbiased manner with the objective to explain, describe, or predict.

Quantitative research contains the following elements:

a hypothesis
a random or specific study group with a common similarity
variables (any element or behavior that can affect or change the outcomes of a study, such as a medication, treatment, or nursing intervention)

Quantitative research is usually conducted in a controlled environment, such as a lab or healthcare unit. It can be categorized as follows.

Correlational research is the methodical investigation of relationships or interactions between two or more variables without determining the cause-and-effect relationship the variables may have on each other. An example is studying two chemotherapy medications for compatibility without studying how the medications can have adverse interactions with food or other common medications.
Quasi-experimental research explores a cause-and-effect relationship among variables. It also evaluates the underlying cause of a problem and studies the effects of variables (such as a nursing intervention) to evaluate their effect on the problem.
Descriptive research offers an accurate representation of the characteristics of a particular individual, situation, or group. Descriptive research is a way of discovering new meaning, describing numerically something that currently exists, determining the frequency with which something occurs, and categorizing information.

Five types of qualitative research

The goal of qualitative research is to generate new insight or knowledge, or to validate existing knowledge. Qualitative research data are usually driven by the participants' thoughts, reactions, perceptions, and experiences. This type of research focuses on systems, steps, rituals, processes, best practices, observations, or personal experiences, and may or may not have an outcome. Qualitative research can be used to gain a better understanding of a topic, inform the reader about how to perform a task, or gain a new perspective on a topic. It's helpful to explain sensitive, unique, and difficult-to-understand information that can't be conveyed quantitatively.

Qualitative research may consist of the following elements:

a hypothesis or theory
an observation through experience or interactive study
practice-based interventions
implementation strategies
casual or formal approaches
approaches to adaptation or variation
how-to guidance
unanticipated adverse reactions if applicable
relevant background or circumstantial factors.

The five types of qualitative nursing research are as follows.

Ethnography involves the analysis or observation of a culture or social group's customs, rituals, and behaviors, and their understanding of disease and illness within that culture. It requires methodical collection, detailed descriptions, and analysis of the information to help refine or develop cultural theories. Ethnographic studies allow the reader to understand a subject group's way of life and the cultural forces that shape the group's rituals, behaviors, thoughts, or feelings. The research may have a specific or global focus; for example, the group's interaction among themselves or with others, or social norms or taboos.
Grounded theory is often referred to as “theory building” because concepts, problems, and theories are continuously reevaluated. It's designed to discover what problems exist in a specific social environment and how these problems are resolved. It involves devising a theory, testing the theory, and refining the theory until the core problem or solution is identified. This type of research often includes personal or professional first-hand experiences. A common core question within grounded theory is, “What's the basic problem and how are we going to resolve or improve it?” An example is a patient describing how he or she copes with existing or new health conditions. Another example: A nurse describes the methodical steps that have improved a patient's experience or health, or resolves the knowledge deficits of other healthcare personnel.
Symbolic interactionism focuses on patterns of communication, interpretation of that communication, and understanding how this communication forces adjustments between individuals who react to their interpretation of their world or social group. This type of research reflects the theory that people behave or react in response to what they believe is true or correct, and not just based on what's objectively true. Teenagers who are overwhelmed with information on the health risks of smoking are one example: Despite this information, they may still smoke because they believe it will help them fit in with their peer group.
Historical research involves understanding and gathering information on the history of a topic, group, or culture. This type of research allows the reader to systematically evaluate historical information via a detailed analysis of past occurrences and guides the reader to what's been proven to be beneficial or ineffective in certain situations in the past. Armed with this knowledge, nurses can develop a plan to improve results or outcomes for their patients, work environment, or clinical practice. An example of this type of research is Florence Nightingale's discovery that unsanitary wound care and infrequent hand washing led to poor patient outcomes and that sanitary wound care with good hand washing improved patient outcomes.
Phenomenology utilizes personal experiences to gain insight, empathy, or knowledge about a specific topic, situation, or “phenomenon.” With this type of research, the investigator attempts to describe or understand a person's or group's perception, perspective, and understanding of a phenomenon and tries to answer the question, “What's it like to experience a given situation?” By understanding how patients view or experience events, nurses can formulate new treatment plans to enhance the healthcare experience or resolve knowledge deficits. By looking at multiple perspectives on the same situation, a researcher can make generalizations about what something is like from an insider's point of view. This research is typically focused on specific topics, such as a patient's response to illness, physical disability, healthcare procedures, or healthcare work environments.

Become an EBP cheerleader

Encourage your healthcare team members to utilize and participate in EBP research studies when opportunities arise. This broadens our knowledge base and allows us to validate our clinical and operational practices. There are numerous ways that you can become an EBP cheerleader in your work area and encourage your healthcare team to be EBP leaders. For example:

consider starting a nursing journal club. Each member can bring a new, relevant EBP study to share with the group at each weekly or monthly meeting.
consult with your healthcare and administrative team about forming an EBP committee within your unit or facility. The group can explore new EBP data that may be beneficial in more than one area or unit of your healthcare facility.
interactively participate in grand rounds with your physicians and other healthcare team members on a regular basis. Engage your colleagues and educate them on new EBP practices, studies, or interventions that may benefit their work environment or patients.

The management team should set the example by supporting and acknowledging nurses who participate in, publish, or otherwise share new EBP research data that may benefit nurses and patients in their facilities and the community. As the field of nursing continues to evolve, we must become proficient in evaluating, participating in, and sharing EBP research with our healthcare team to improve our clinical practice and our patients' outcomes. To read more about EBP research, visit http://nursingplanet.com/Nursing_Research/ .

Caution: permission required

Don't approach patients, families, or coworkers about participating in a research study until you've provided your healthcare facility with a clear research plan, including a hypothesis, objectives, and known variables. After presenting the research plan, obtain permission according to your healthcare facility's policy.

To proceed with research, you must typically obtain permission from your healthcare facility, governing bodies, management teams, ethical standards boards, patients, families, and coworkers, if applicable. Patients recruited for the research should be given full disclosure of all the known variables so they can make informed decisions that are consistent with their ethical values and beliefs.

It's important for all members of the research team to be socially and ethically considerate of all participants in a research study. Never pressure, coerce, or exert direct or indirect pressure on any potential participant in a research study.

Learn the lingo!

Research studies often contain language that may be unfamiliar to nurses. Don't be intimidated! You can easily learn the basic lingo that's commonly found in research studies, such as:

abstract : a brief summary or overview of the research study.
case study : a collection of detailed information about a person or specific group.
causality : the relationship between the cause and effect of a situation or event.
consent : an agreement given by a competent person to participate in a research study.
control group : randomly selected participants from the research group who won't receive the experimental treatment or variable. Those in the control group will be compared with those receiving the treatment or variable under investigation to establish the effectiveness or ineffectiveness of the variable/treatment.
double-blind study : a research study conducted in which neither the investigators nor the participants know specific details of the study, such as whether a placebo or trial medication is being administered.
experimental research group : randomly selected participants from the research group who will receive the experimental treatment, medication, or variable.
hypothesis : an educated guess about the expected outcome of a study.
mean : the average score between two variables or outcomes.
single-blind study : a research study conducted in which the investigators know specific details of the study but the participants don't.
variable : an intervention, action, or medication that's being studied to observe its effect on the research group. For example, a group of oncology patients may receive a new cancer medication to study its effectiveness on reducing tumor cell growth. In this scenario, the new medication is the intervention or variable.

memory jogger

When conducting research, think DIDACTIC .

D evelop a hypothesis

I dentify common variables

D esign (pick a specific research design)

A cquire pertinent data such as past medical records

C ommunicate your research goals with the healthcare team

T alk with the research study participants (goals, risks, and benefits)

I mplement your plan after you obtain the participants' written consent

C ollect the data and write your conclusion

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Mobile App Integration

Integrated Care is a unique systematic approach that enables access to mental health care to be improved through a team-based approach consisting of primary care providers, behavioral health providers, psychiatric consultants, and the patient.

However, despite how effective these systems can be, there are still challenges for meeting the needs of the underserved patients encountered in the primary care environment. To meet these needs, we have been exploring the feasibility of using mobile apps among the underserved. Notably, we have looked at provider perspectives, patient perspectives, workflows, and necessary training related to mobile app use, along with developing foundational knowledge needed to use apps for conditions commonly encountered in primary care settings, including perinatal depression, anxiety, and trauma.

Proposed Framework for incorporating Mobile Apps into Integrated Care Environments:

Selected Citations

Emerson, M.R ., Watanabe-Galloway, S. , Dinkel, D. , Kotcherlakota, S., & Fok, L. (2020). Lessons Learned in Selection and Review of Depression Apps for Primary Care Settings. Journal of Technology in Behavioral Science . https://doi.org/10.1007/s41347-020-00156-5 . +

Emerson, MR. Caspari-Harsh, J. Notice, M., Dinkel, D. , & Kabayundo, J. (2021). Mental Health Mobile App Use: Considerations for Serving Underserved Patients in Integrated Primary Care Settings. General Hospital Psychiatry . 67-75. +

Dinkel, D.M. , Caspari, J.H., Fok, L., Notice, M., Johnson, D.J. , Watanabe-Galloway, S. , & Emerson, M.R . (2021). A Qualitative Exploration of the Feasibility of Integrating Mental Health Apps into Integrated Primary Care Clinics. Translational Behavioral Medicine. 11(9), 1708-1716.+

Emerson, MR., Perret, S., Chinn, H. , Alon, N., Watanabe-Galloway, S. , Johnson, D. , Dinkel, D. , Torous, J. (2003). A systematic review and exploration of smartphone app interventions for perinatal depression with case study. Springer Current Treatment Option in Psychiatry. 10(5) doi: 10. 10.1007/s40501-023-00301-w

King, D., Emerson, MR ., Tartaglia, J., Nanda, G., and Tatro, N. (2023). Methods for Navigating the Mobile Mental Health App Landscape for Clinical Use. Current Treatment Options in Psychiatry. Published online 5.24.23. DOI: 10.1007/s40501-023-00288-4

Return to the Hilltop ‘A Dream Come True’ for New Director of Doctor of Nursing Practice Education

(August 16, 2024) — Stephan Davis, DNP, MHSA, NEA-BC, CENP, CPHQ, CNE, FACHE, FAAN, who takes over as the Georgetown University School of Nursing’s new director of Doctor of Nursing Practice (DNP) education this fall, said returning to Georgetown, where he earned his master’s degree in health systems administration in 2009, “feels like a dream come true.”

“I’ve always loved the Hilltop,” he said. “I cherished my time there as a student and actually worked at Georgetown as director of the Health Workforce Innovation Project. So it’s great to come back after 15 years of being away.”

The fact that Georgetown is situated in Washington, D.C., the nation’s capital, serves as an extension of the classroom, Davis said, which he sees as “very rich” for students.

“I just think that Georgetown’s a really unique space, both in terms of the university itself, its location in D.C., and the Jesuit values, which permeate everything that we do at the university,” he added.

Improvising on a Change of Path

Originally from St. Louis, Missouri, Davis moved to New York City as an undergraduate jazz saxophone major. However, his vision for the road ahead began to shift as courses in anthropology and sociology exposed him to issues that awakened a curiosity about health care and the impact of social determinants of health.

“That’s what led me to nursing,” he explained.

Davis transferred to the University of Maryland in Baltimore and earned his undergraduate nursing degree in 2007. Following his graduate degree at Georgetown, he earned a Doctor of Nursing Practice in 2016 at Yale, focusing on health care leadership, systems and policy. Then, in 2023, he earned a postgraduate certificate in evidence-based teaching in the health professions from Johns Hopkins University in Baltimore.

His career arc during those years has taken him from MedStar Washington Hospital Center in D.C. to New York’s Metropolitan Hospital, the Miller School of Medicine at the University of Miami, Georgia State University’s Lewis College of Nursing and Health Professions in Atlanta, the University of North Texas Health Science Center’s School of Public Health in Fort Worth, and executive director, assistant and associate dean positions at Virginia Commonwealth University’s College of Health Professions and School of Nursing in Richmond.

Staying True

Davis’ roles at VCU focused heavily on diversity, equity and inclusion and inclusive excellence and belonging. He has also served on numerous committees on DEI-related issues at the schools where he’s been on faculty, and is a current member of the American Academy of Nursing’s national DEI committee.

Davis said coming home to Georgetown aligns perfectly with the emphasis on access, advocacy and combating bias — in education as well as in practice — that’s been a large focus of his career. While many other universities have scaled back DEI efforts, Georgetown has remained true to its founding Jesuit values and its commitment to DEI.

“One of our core values is ‘People for Others,’” Davis said. “That’s what we’re cultivating with our students. And I think that it’s for all others. It’s for anyone who’s been othered or excluded.

“I think that Georgetown is a place where we really teach our students that it’s about creating access and cultivating inclusion and belonging for everyone,” he added. “The commitment to health equity and educational access are exemplified through a number of initiatives at Georgetown.”

He credited outgoing program director Peggy Slota, DNP, RN, FAAN, as well as faculty members for establishing Georgetown’s DNP program and added that his own goal is to see it be “the degree program of choice for nurses who want to lead change and transform health care and influence health policy. I really want it to be the destination for nurse leaders.”

The Beat Goes On

Alongside his career, Davis has kept up with the sax and performs as a soloist at special events. While a student at Georgetown, he was one of the featured artists at the university’s “Let Freedom Ring!” celebration of Martin Luther King Jr. at the Kennedy Center for the Performing Arts, performing “Amazing Grace” as a prelude to Aretha Franklin’s finale.

“Nolan Williams Jr. was the music director for that event and continues to serve in this capacity,” Davis said. “He was also the music director for the American Academy of Nursing’s 50th-anniversary celebration, where I had the opportunity to collaborate with him again last year.”

Michael von Glahn GUMC Communications

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News and Views

Hazardous Drug Surface Contamination Prevails, Despite More Diligent PPE

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One potential positive from the COVID-19 pandemic was heightened awareness and use of personal protective equipment (PPE). However, protecting people from virus transmission does not automatically equate to protecting surfaces from hazardous drugs, researchers reported in the August 2024 issue of the Clinical Journal of Oncology Nursing (CJON). Although surface contamination varied by agent and setting, overall, they found no significant change from pre- to post-pandemic.

The research team, which included ONS members AnnMarie Walton, PhD, MPH, RN, OCN®, CHES, FAAN, and Haesu Jin, MSN, RN, AGACNP-BC, BMTCN ® , conducted the study on two adult hematology-oncology inpatient units at their organization. They surveyed nursing staff who worked on the units both before the pandemic (BP) and during the pandemic (DP) about their use of the following PPE items for chemotherapy administration, chemotherapy disposal, and contaminated excreta:

Gloves labeled for use with chemotherapy
Double gloves
Gown labeled for use with chemotherapy
Eye protection
Respirator or mask

They also asked questions about:

Knowledge about chemotherapy exposure
Perceived risks of chemotherapy exposure
Self-efficacy for using PPE
Perceived barriers to using PPE
Interpersonal influence regarding use and importance (e.g., peers’ use of PPE, supervisor encouragement)
Perceived conflict of interest (e.g., having to choose between efficiency in patient care and PPE use)
Workplace safety climate (e.g., PPE availability, managerial support, job hindrances, feedback and training, orderliness and cleanliness, conflict, or communication)

Overall, they found that nurses’ PPE use was significantly higher DP than BP when handling antineoplastic drug–contaminated excreta and that more nurses were using gloves labeled for use with chemotherapy, more than 75% of the time DP than BP. Nurses also reported a lower perceived risk of chemotherapy exposure DP than BP. Among the other factors influencing use, increased conflict of interest and perceived barriers were both linked to lower PPE use, whereas increased importance of personal influence was linked to higher PPE use.

The researchers then conducted a surface wipe analysis on each of the two units on two different days, BP and DP. They collected 68 samples from 18 surfaces in shared areas and 68 samples from 17 surfaces in 4 patient rooms after patients received cyclophosphamide, etoposide, or both, for a total of 136 surfaces (68 shared surfaces and 68 patient room samples).

They found that surface contamination was present and generally at similar levels for both BP and DP. Cyclophosphamide was detectable and quantifiable on 65% of surfaces DP and 62% BP, whereas etoposide was detectable and quantifiable on 27% of surfaces DP and 31% BP. More than 50% of shared areas and 70% of patient rooms had detectable and quantifiable levels of cyclophosphamide BP and DP.

What did differ between the two time points was surface contamination with etoposide: For shared surfaces, it was significantly higher DP than BP, whereas for patient rooms, it was significantly lower DP than BP.

“These results suggest that, in addition to PPE use, greater attention must be given to administrative controls (e.g., nurse–patient ratios, training) and engineering controls (e.g., closed-system transfer devices at the point of administration) to limit surface contamination with antineoplastic drugs,” the researchers concluded. “Effective administrative controls ensure adequate job training, retention, and staffing.”

Learn more about the findings by reading the full CJON article , then get a glimpse into the study approach and methods in the following video, where CJON Editor Joni Watson and primary author AnnMarie Walton delve deeper into the science behind the study.

Personal Protective Equipment (PPE)

What’s ahead for clinical practice?

Many key issues in the practice of psychology center around technology and telehealth

Vol. 55 No. 1 Print version: page 80

Practice Management

[ This article is part of the 2024 Trends Report ]

Telehealth enters a new normal

The Covid -19 pandemic threw telepsychology into overdrive overnight. Now, nearly 4 years later, the practice of psychology at a distance is settling into a new normal, but new policies around reimbursement and data privacy are still being hammered out.

The federal Public Health Emergency (PHE) enacted at the onset of the coronavirus pandemic expired in May 2023. Prior to the PHE, Medicare and Medicaid reimbursed for telehealth at a lower rate than in-person therapy, said Stephen Gillaspy, PhD, senior director of the Office of Health and Health Care Financing. Under the PHE, these rates were made equitable. Now that the PHE has expired, the Centers for Medicare and Medicaid Services (CMS) has announced that the agency will continue to pay for telehealth and audio-only mental health services at the same rate as in-person.

“That’s very positive,” Gillaspy said.

But questions remain about psychological and neuropsychological testing via telehealth. These were included in reimbursement under the PHE, and CMS has extended waivers to continue to reimburse for them via telehealth for the time being. Whether that policy will persist long term, however, is not clear, Gillaspy said.

On the state and private insurance levels, the policies are mixed, but there seems to be an acceptance of the fact that many practitioners are moving to a hybrid model: seeing patients in-person at times and virtually at others, Gillaspy said. A survey this year by the New York State Psychological Association found that 96% of respondents reported delivering at least some services via telehealth. The respondents were not a representative sample of all psychologists—or even all New York psychologists—said Barbara Meehan Reyes, PhD, a clinical psychologist and the chair of the Psychology Interjurisdictional Compact (PSYPACT®) Subcommittee for the association, but the overwhelming number hints at how common telepractice has become.

[ Related : Here’s how psychologists are serving patients with lower incomes ]

There has been some concern that if payers saw practitioners moving en masse to virtual-only practice, they might slash reimbursement rates, because those practitioners would no longer be maintaining a physical office and have reduced practice expense, Gillaspy said. So far, however, that does not seem to be the most common arrangement. “When I talk to insurance companies and regulators, I talk about how the vast majority of people are going to continue to provide the full array of services,” he said. “Most people think about services in which the default is in-person, but with telehealth as an option.”

Closing a physical office can also be a challenge, because using one’s home address as a business address enters it into the public record, which can be undesirable for many mental health practitioners. Several insurance companies and Medicare require the use of physical addresses for providers and will not accept a P.O. box or a UPS-center address, said Marnie Shanbhag, PhD, senior director of the Office of Independent Practice at APA. “You’re going to have to think about how comfortable you are with your home address being on your billing,” she said.

Another perennial concern for telehealth is privacy. Earlier this year, Zoom rolled out a plan to leverage user data for artificial intelligence (AI) training, which they had to walk back after user outcry, said Deborah Baker, JD, director of legal and regulatory policy at APA. Instances such as that raise questions about how to govern the use of big data. “Our members are becoming more sensitive to the use of data, and what the limits are in terms of technology in practice,” she said.

The U.S. Department of Health and Human Services has issued several invites for public comment on these data and security issues in telehealth in the last year, Baker said, while several states have enacted consumer data privacy laws that are stronger than what HIPAA alone would mandate. As a result, many telehealth platforms now issue additional protections for residents of those states. Patients, too, are becoming savvier about the policies of the tech tools they engage with, Baker said.

“Now users are starting to be more thoughtful and read the fine print about how data is being used a little more closely,” she said.

PSYPACT widens practice across state lines

PSYPACT now encompasses 39 states, enabling participating psychologists to see patients across state lines without having to get separate licensure in each state. A 40th state, Vermont, has enacted PSYPACT legislation and will become active this year.

The compact has been adding roughly six members a year in recent years, said Janet Orwig, executive director of the PSYPACT Commission, the compact’s governing body. This rate will likely slow, given the relatively few states and territories left outside of PSYPACT, Orwig said, but there is still interest in these areas.

“Folks are providing an increasing amount of mobile services to an increasingly mobile population,” said Reyes.

New York has not yet enacted PSYPACT but was one of two states, along with Massachusetts, with active PSYPACT legislation in 2023. In New York, Reyes said, the association is currently seeking a majority lead sponsor in both legislative houses for the bill, which is necessary for moving legislation through the New York state system. Other states, including Mississippi and Hawai’i, had bills in committee in 2023, but time ran out in the legislative session before they could come up for a vote. Hopefully, Orwig said, those bills will be reintroduced in 2024. In all, 12 states saw PSYPACT bills in 2023, and six enacted them.

The New York State Psychological Association began pursuing membership after a “groundswell of interest” from members, Reyes said. “It really is far less cost-prohibitive and far less logistically challenging to practice with PSYPACT than it is to pursue licensure in multiple states,” she said.

New York psychologists have a patient base prone to cross state lines, Reyes said. Patients may live in Connecticut, work in New York, and have a second house in a third state, Reyes said, or they may commute as far away as Washington, D.C.

PSYPACT is also helpful when a patient moves out of state permanently, Reyes said; they can continue receiving care from the provider they’ve already built rapport with, or at least have a cushion before transferring to a psychologist in their new state.

“What we have heard most from our members is that their client base was increasingly more mobile, and they are finding it difficult to provide ongoing service and continuity of care,” Reyes said.

[ Related : Making digital interventions accessible and affordable ]

Many of the challenges to adding additional states to the compact are a matter of education and outreach for local legislators, Orwig said. Especially in states that don’t have compacts for other professional licensures, PSYPACT can be new territory. New York is one of those states, Reyes said, which means that policymakers have to consider the possible impacts on other professions and on the regulatory framework surrounding licensing before they set final rules.

PSYPACT is currently working on developing its first strategic plan, Orwig said, beginning with surveys of the individual practitioners who hold PSYPACT authorization. One theme, she said, is that PSYPACT allows psychologists in specialty areas to expand their reach, bringing their services to patients who would not otherwise have options in their regions. As a result, PSYPACT is helping address the psychologist shortage, said Shanbhag.

“Maybe the pediatric psychologists in our state are booked out several months, but you can get one in the neighboring state in 3 weeks,” she said. “It helps you get care much more quickly, and you can get much wider access for specialty care.”

There are still implementation questions around PSYPACT and billing, said Baker. It can be tricky to navigate payment when a provider is in-network for a national insurance company but not in-network in any of that company’s plans in the state that they are practicing in remotely. APA has begun educational outreach to payers in order to understand their level of awareness of any provider policies around PSYPACT.

“My hope is that interjurisdictional practice is becoming more streamlined under PSYPACT, and more resources are made available to psychologists practicing under PSYPACT, so providing care across jurisdictional lines is easier,” Baker said.

Ultimately, Orwig said, it’s unlikely that every single state and territory will join PSYPACT; it’s rare for any cross-state compact to achieve universal reach. And she expects to continue adding new PSYPACT members at a slower rate going forward.

“If we can add one or two per year going forward,” she said, “that will be really excellent.”

AI’s gradual integration into practice

As machine learning grows more powerful, researchers and health systems are starting to explore bringing AI into practice. However, while some tools are already being used by larger organizations to help streamline administrative tasks, it’s still uncommon to see AI digital therapeutics used in direct patient care. ( See What psychologists need to know about the evolution of generative AI .)

“We don’t have a lot of saturation of these products in the hands of clinicians because there’s just not a reimbursement pathway yet,” said C. Vaile Wright, PhD, senior director of the APA Office of Health Care Innovation. “The products exist, but how much they’re being used is unclear.”

Unlike health and wellness apps that are prohibited from making medical claims about their outcomes, digital therapeutics are under the purview of the U.S. Food and Drug Administration, Wright said. But the health care regulatory and reimbursement systems are not designed for innovative products or for the idea of software as a medical treatment, she said. That has led to slow implementation even as companies and academic researchers develop algorithms for everything from matching patients with potential providers to monitoring of passive suicide ideation. Expanding the use of AI as a tool in practice will likely require careful testing, a rethinking of regulatory categories around innovative technologies, and the cultivation of trust in technology from both clinicians and patients.

“I don’t think we’re quite ready for AI or similar approaches to be used in direct care without human oversight, but there are a lot of exciting opportunities for AI in supporting the care that is being provided by trained professionals,” said Victoria Bangieva, PhD, a clinical psychologist who advises technology companies developing mental health tools, as well as a member of APA’s Mental Health Technology Advisory Committee. “That’s what we’re seeing happen.”

For instance, HIPAA-compliant services such as Mentalyc or Eleos will transcribe session transcripts into insurance-ready progress notes, reducing the time therapists must spend on non-patient-facing activities. Some larger systems are also using algorithms to match patients to the provider most likely to suit their needs, Bangieva said. Some services are also used to coach clinicians, giving them suggestions of which treatment paths to pursue. In the United Kingdom, the National Health Service is using Ieso, a service founded by two psychologists to provide online typed therapy. The company is working to use AI to analyze what human therapists write in these sessions and tie it to outcomes, in the hopes that AI can help therapists understand which concepts and phrasings are most effective.

“There is a lot of excitement around AI, but we’re still quite early on, and there needs to be a bit more validation of the models and the different tools that are being built,” Bangieva said, particularly in a real-world environment. AI always carries a risk of perpetuating preexisting biases, Wright said—if bad data go in, bad data come out.

“Algorithms are written by people,” she said, “and if you’ve got people with biases using data that’s biased, what are the unintended consequences in perpetuating what is already an inequitable system?”

Nevertheless, these tools are important to pursue, she said, because there are simply not enough providers to handle the mental health need without additional help. There are efforts underway to create a framework around both data management and reimbursement for the use of these tools. Earlier in 2023, CMS solicited a request for information about digital therapeutics from stakeholders. A response to those comments outlining next steps from the federal payer is expected at the end of 2023, Wright said.

A final hurdle for the development of AI in mental health right now involves training, said Ross Jacobucci, PhD, an assistant professor of psychology at the University of Notre Dame, who is working on a project using machine learning to monitor suicide risk using screenshots of people’s cell phone activity. There are relatively few people who are trained in both big data and psychology, Jacobucci said, and most psychology graduate programs lack the in-house statistics classes needed to work in machine learning. Students who want to work on the tool-development side should look to outside workshops on AI and machine learning, he said. Fortunately, more and more graduate programs are providing funding for students to get that expertise from third parties, he added.

“It’s really difficult for a clinical person to speak to somebody in computer science if neither of them has worked with the others’ type of data,” Jacobucci said. “I do think there are a lot of people with the skill set that want to work with both.”

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