The ACE Center provides a focal point for evidence-based practice activities, including education and interdisciplinary research projects. Projects and investigations are concentrated on two objectives: (a) basic and professional level workforce development for EBP; and (b) the study of the processes and outcomes within evidence-based quality improvement. We study evidence synthesis, translation of evidence into practice, and healthcare provider and organizational change. A short description of representative projects and research follows.
Current Research Topics
List of Topics
- ACE Translational Research
This ongoing program expands and tests a model for understanding evidence-based practice. The study of EBP is essentially the study of transforming knowledge produced through primary studies and moving it through adoption into clinical decision-making.
Using the ACE Star Model as a framework, our program of translational research investigates phenomena associated with EBP, including summarizing evidence, clinical guideline development and uptake, organizational culture, and outcome measures. The initial project in this timely program of research was Evaluation of Systematic Reviews Published in Nursing Literature: A Replication, that pointed to the need for more rigorous systematic reviews in nursing. Subsequent projects investigate factors associated with uptake of clinical practice guidelines, innovation, and system culture change.
- ACE Star Model of Knowledge Transformation
Developed in 2004, the ACE Star Model is configured as a simple 5-point star; and it explains how knowledge is transformed at five major stages, starting from primary research, and continuing through the stages of evidence summary, translation, integration, and evaluation. This model places nursing’s previous scientific work within the context of EBP and is proving useful for examining the EBP process, roles in EBP, and research methods with which to investigate EBP.
Adopted by scores of hospitals across the nation as part of their journey to excellence, the ACE Star Model forms a foundation for developing workforce competencies, organizing projects, and employing EBP in clinical settings. Influenced by Imogene King, we continue to evolve the ACE Star Model as a theory, combining concepts of knowledge transformation with elements of communication, mutual goal setting, and systems theory.
- Improvement Science Research Network
While quality improvement activities are highly encouraged in acute care settings, hospitals and improvement scientists are not well connected. The lack of established research teams, limited access to the clinical care laboratory, and small sample sizes hamper attempts to produce rigorous and externally valid quality improvement studies at a time when these are a national priority in healthcare. The research partnerships promoted by national advisors (e.g., IOM, 2004) and structured through the National Institutes of Health, Clinical and Translational Science Awards (CTSAs) provide tremendous opportunity to engage academic and clinical scientists and clinicians across multiple agencies in a network that is focused on improvement and translational science. The purpose of this series of projects is to build a national Practice-Based Research Network for Improvement Science in acute care settings. To learn more about conducting research through ISRN, visit www.ISRN.net.
Funded: National Institute for Nursing Research, NINR/NIH; Delta Alpha Sigma Theta Tau International; national funded.
- AHRQ Health Care Innovations Exchange
The ACE center is a partner in the development of the AHRQ Health Care Innovations Exchange. Participating as part of the Westat, Inc. project team, we are building this comprehensive online program to accelerate development and adoption of innovations in health care delivery. The Innovations Exchange aims to increase awareness of innovative strategies and activities among health care providers in a timely manner through offering a set of searchable innovation profiles, quality tools, learning opportunities to enhance rapid adoption, and networking opportunities.
Funded: Agency for Healthcare Research and Quality
- Building Team Performance for Patient Safety: TeamSTEPPS™
TeamSTEPPS™ is the standardized federal program for healthcare team training. The new teamwork system optimizes team performance in order to resolve communication breakdowns, known to be a major contributing factor to sentinel events in patient safety.
Seen as a premier example of moving evidence into practice, this evidence-based teamwork system advances quality, safety, and efficiency of patient care by improving communication and other teamwork skills among healthcare professionals. As part of the National Implementation of TeamSTEPPS project, the Department of Defense (DoD), the Agency for Healthcare Research and Quality (AHRQ), and ACE have partnered to build a national support network to move this effective system into healthcare agencies and professional education and to study its impact.
Funded: Implementation projects have been funded from multiple sources.
- Small Troubles, Adaptive Responses: Fostering a Quality Culture in Nursing
This study aims to improve nursing units’ quality and efficiency. The study will investigate whether a program designed to address small problems encountered by nurses in patient care will drive large improvements in safety, quality, and efficiency. The analysis applies a logic model specifying the pathway from inputs to actions to intermediate outcomes such as new problem solving strategies to ultimate outcomes such as improved nursing quality benchmarks and reduced adverse events.
Funded: This 2-year intervention study is funded through the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI). Co-PIs Kathleen R. Stevens, EdD, RN, ANEF, FAAN and Robert L. Ferrer, MD, MPH.
- Consensus on EBP Competencies in Practice & Education
The purpose of this project is to establish a national basis for developing competencies in EBP for nurses. Through multiple iterations, panels of experts engaged in consensus formation regarding EBP competencies that should be integrated into nursing education and practice roles. The consensus is published in Essential Competencies for Evidence-Based Practice in Nursing.(2nd ed. Stevens, 2009)
The initial 3-year project established 20 to 30 competencies for basic (UG), intermediate (MS), and advanced (Doctoral) preparation in nursing. These competency statements are organized into five stages of knowledge transformation, based on the ACE Star Model (Stevens, 2004). Core competency statements are presented at a detailed level in order to guide curriculum revisions. This work guides incorporation of EBP skills and content into nursing positions and into nursing education programs. Consensus work was extended by Dr. Paula Clutter to create competencies for ADN education. The project continues to verify and disseminate the findings.
This work guides incorporation of EBP skills and content into nursing education programs and into clinical nursing. Health care agencies have used the Essential Competencies as the basis for developing the EBP ‘leg’ of clinical career ladders and performance standards. Extension and evolution of the competencies continues. Information for purchasing the latest edition of Essential Competencies for Evidence-Based Practice in Nursing 2nd ed. is available from ACE at firstname.lastname@example.org .
Funded: Consensus work has been funded from multiple sources.
- Ace Evidence-Based Practice Readiness Inventory (ACE-ERI)
The ACE-ERI was developed through methodologic research studies in response to a national need for assessment approaches in nursing competencies. Using the foundation built in the Essential Competencies work, the self-report instrument was developed and utilized by all levels of nurse clinicians, educators, and students. Psychometrics studies involving over 1,500 participants demonstrated the strength of the ACE-ERI in terms of reliability and validity. Offered primarily as an online survey, the ACE-ERI has been used in hospitals and schools of nursing across the country to benchmark progress in EBP competencies. Its usefulness in further research.
Funded: Development projects have been funded from multiple sources including National League for Nursing, Delta Alpha Chapter of Sigma Theta Tau, The University of Texas Health Science Center, and resources from collaborating hospitals and schools.
Collaboration Opportunties for Students, Faculty, and Clinical Agencies
The ACE center provides a focal point for evidence-based practice activities including education and interdisciplinary research projects. A short description of representative areas follows.
Faculty and students are invited to collaborate.
Sample of Completed Research Studies
- Quality of Systematic Reviews in the Nursing Literature.
PI: Dr. Kathleen Stevens.
Funded by the Delta Alpha At-Large Chapter of Sigma Theta Tau International, ACE’s first research project in its program of translational research examined the quality of Systematic Reviews - as indexed by CINAHL - in the Nursing literature. For this pilot study, critical appraisal of 10 randomly-selected articles was done using the Overview Quality Assessment Questionnaire (OQAQ) (Oxman, A. D., & Guyatt, G. H., 1991). The study pointed to the need for rigor in systematic reviews and caution in labeling non-systematic reviews.
- Dissertation: Factors Related to Uptake of Clinical Practice Guidelines. (2006)
PI: Paula Clutter.
A study of CPG uptake, this work was accomplished through collaboration with VERDICT to examine factors associated with uptake of evidence-based guideline implementation in healthcare agencies. Partially funded by an award from the Delta Alpha At-Large Chapter of Sigma Theta Tau International.
- Demonstration Project: Ventilator Associated Pneumonia (VAP): Improving Outcomes Through Best Practice Implementation. (2004)
Contracted by a TriService Research Grant, ACE, BAMC, and Wilford Hall nurse teams developed, implemented, and evaluated impact of best practice in VAP.
- Evidence-Based Youth Smoking Cessation. (2000 - 2003)
PI: Dr. Kathleen Stevens.
Funded as a Community Health Initiative of the University Health System, this project focused on helping teens quit smoking. About 80% of teens who smoke have tried to quit...only 1.5% are successful without assistance. This points to a great need for teen sensitive smoking cessation programs. In San Antonio and in most other cities, major emphasis of youth tobacco control is on prevention. But many teens 'slip through' this safety net...33% of public high school teens in Texas smoke! In 2000, the project partnered with American Lung Association and assembled 'best evidence' on intervening with smoking teens. With this research evidence, ACE activated the community and schools through the San Antonio Teen Tobacco Coalition to translate the evidence into best intervention programs. The EBP interventions were implemented and evaluated in high schools using a community partnership approach and achieved the same cessation rates as the longer program.
- Dissertation: Pregnancy-related Factors and Smoking Stauts in Pregnant Hispanic Adolescents. (2004)
PI: Dr. Laura Munoz.
This project examined the structure of factors between pregnancy and smoking in this population.