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7703 Floyd Curl Drive,
MC 7949,
San Antonio, TX 78229-3900
Phone:  210-567-1480
Fax:  210-567-5822

For More information Email:  acestar@uthscsa.edu

CURRENT RESEARCH

COLLABORATION OPPORTUNITIES FOR STUDENTS,

FACULTY AND CLINICAL AGENCIES

The ACE center provides a focal point for evidence-based practice activities including education and interdisciplinary research projects. Investigations focus on two facets: (a) the study of the processes within evidence-based practice; and (b) investigations of clinical problems. A short description of representative projects follows. Faculty and students are invited to collaborate.

1. SUMMER INSTITUTE ON EBP.  ACE sponsors interdisciplinary education     programming at the national Summer Institutes for Evidence-Based Practice. Noted EBP leaders are featured in this unique coordinated-curriculum conference. This institute prepares healthcare providers from multiple disciplines for an increasing role in evidence-based practice to improve healthcare. Funded by the Agency for Healthcare Research and Quality, the Institute is coupled with pre and post-doctoral course studies.  Summer Institutes are held annually in San Antonio. Further information is available at www.acestar.uthscsa.edu.
   
   
2. QUALITY AND SAFETY.  Services are offered that will assist clinical agencies to establish best practice, improve quality, and enhance safety in clinical care. Health care agencies and nurse administrators may contract such services. Faculty and students involved in establishing best practices can use EBP resources from the ACE library and assistance from ACE support staff and initiate/link with best practice groups.
   
   
3. ACE STAR MODEL OF KNOWLEDGE TRANSFORMATION.  This ongoing investigation tests and expands a model for investigation of evidence-based practice. The study of EBP is essentially the study of transforming knowledge produced from original studies through adoption of the knowledge into a basis for clinical decision-making. Using the ACE Star Model, ACE is investigating questions such as: What is  the state of the science-e.g., the synthesis of all that is known about a clinical treatment? Given the science, how should recommendations for practice be developed and packaged? What facilitates and hinders healthcare providers and organizations from adopting the change? What impact does the practice change have on outcomes such as health status and cost? Configured as a simple 5-point star, the model explains how knowledge is transformed at five major stages, from original research, through the stages of evidence summary, translation, implementation, 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 to investigate.
   
   The Star Model has received national attention from both clinical agencies and nursing education programs as a parsimonious yet clear representation of the basis of EBP -- FORMS of knowledge. The Star Model was used by a national panel to set consensus on Essential Competencies for EBP. Education for EBP using the Star Model is available every summer in the Summer Institute on EBP.
   
   
4. COLLABORATIVE & CONSULTATIVE RESOURCES.  ACE offers a number of collaborative research opportunities to engage agencies in conducting research (also meets Magnet criteria).
   
   
5. INTERACTING SYSTEMS THEORY – Dr. IMOGENE KING.  Dr. Imogene King (famous nurse theorist) sought out Dr. Stevens at the 2006 Summer Institute on EBP because of the Star Model. Drs. King and Stevens are working on updating Dr. King’s theory to include EBP via the ACE Star Model.
   
   

6. QUALITY OF SYSTEMATIC REVIEWS IN THE NURSING ITERATURE. 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 translation 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).
   

7. TEACHING EVIDENCE-BASED PRACTICE. Drs. Kathleen Stevens and Vicki Byers. The goal of this multifaceted activity is to develop and test professional development  programs, education materials, and models to assist rapid building of EBP capacity in both nursing education programs and clinical settings.  Resources include a free slide presentation – “Introduction to EBP” – complete with lecture notes.  Individual consultation is also available. Annually, The Educators' EBP Workshop® is offered.
   
   

8. CONSENSUS ON EBP COMPETENCIES IN PRACTICE & EDUCATION. ACE team led by Dr. Kathleen Stevens. The purpose of the project was to establish national consensus on competencies in EBP for nurses. 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. The project continues to verify and disseminate the findings. Booklets containing the competencies may be ordered from

   http://www.acestar.uthscsa.edu/Competencies.html.
   
   

9. DEVELOPMENT AND PILOT TESTING OF THE ACE EBP READINESS INVENTORY (ACE-ERI) WITH CLINICIANS. PI: Dr. Kathleen Stevens. Measurement of EBP readiness, preparedness, and competencies is still in its infancy. A number of instruments to measure EBP skills have been developed but they focus on limited aspects of EBP or were developed in the previous, outdated paradigm of research utilization. To meet the need to measure comprehensive EBP skills, ACE is developing and pilot testing an online instrument that measures self-reported EBP competencies – the ACE Evidence-Based Practice Readiness Inventory (ACE-ERI). This inventory is based on the nationally-established EBP competencies (Stevens, 2005). The purpose of this study is to estimate the psychometric properties and utility of the ACE-ERI. The initial study sample was drawn from a population of practicing nurses from across the country enrolled in the 2006 Summer Institute on EBP who completed the paper/pencil version of the ACE-ERI.  Additional clinician groups will complete the online version of the ACE-ERI, including participants of the 2007-2010 Summer Institutes on EBP and clinicians from various hospitals.
   
   Revision (streamlining) of the ACE-ERI occurs in May 2007, based on ACE’s analysis  of over 500 cases. The revised ACE-ERI will then be ready for Phase-2 testing. Nursing education programs and healthcare agencies will be invited to apply to be collaborative data collection sites for Phase 2 (Fall 2007 – Summer 2008).     
    
10. DEVELOPMENT AND PILOT TESTING OF THE ACE-ERI WITH STUDENTS. PI: Dr. Kathleen Stevens. Funded by an Innovative Teaching Grant, the ACE-ERI is being tested among undergraduate and graduate nursing students in three universities. The objectives of this project are as follows:
    
         •   Establish the validity, reliability, and usability of the ACE-ERI
         •   Identify the EBP knowledge and skill level of respondents
         •   Compare respondents’ self-classification of EBP knowledge and skills
              with the scale score
         •   Determine relationships between selected demographics and the
             ACE-ERI scale
         •   Begin to identify gaps in the undergraduate and graduate nursing curricula
              related to EBP knowledge and skills.   
    
    
11. DEVELOPMENT AND PILOT TESTING OF THE ACE-ERI WITH MASTERS STUDENTS. PI: Dr. Vicki Byers. Funded by an award from the Delta Alpha At-Large Chapter of Sigma Theta Tau International, this study will examine a subset of the ACE-ERI WITH STUDENTS project – masters students enrolled in The University of Texas Health Science Center at San Antonio, School of Nursing.    
    
    

12. ONLINE TEACHING-LEARNING MODULES FOR EVIDENCE-BASED PRACTICE: DEVELOPMENT AND TESTING. PI: Dr. Kathleen Stevens. Given the relative lack of training of health professionals in evidence-based quality improvement (IOM, 2003), well-grounded and proven education programs will build capacity for faculty/scientists and students to conduct research and apply translational science. The annual Summer Institutes on Evidence-Based Practice provide such needed training. However, while these Institutes attract many from across the nation, this number is a small fraction of those wishing to expand skills in translational science. As a response to this need, ACE is developing online teaching-learning modules for evidence-based practice. This project, partially funded by the Delta Alpha At-Large Chapter of Sigma Theta Tau International, will develop online streaming video modules, using cutting edge technology. These modules will be delivered and tested for online functionality, ease of navigation, and impact on two learning outcomes: post test of knowledge contained in the module and self-report on the ACE EBP Readiness Inventory (ACE-ERI).  Modules will contain streaming video presentations with corresponding slide shows, learning objectives, pre and post-tests, content outline, and supplemental resources. Additionally, modules will be indexed to Essential Competencies for Evidence-Based Practice in Nursing (Stevens, 2005), assuring that the learning activities are directly related to nationally-endorsed learning outcomes.
    
    

13. DISSERTATION DEVELOPMENT: FACTORS RELATED TO UPTAKE OF CLINICAL PRACTICE GUIDELINES. PI: Paula Clutter, doctoral candidate. A study of CPG uptake, this work is being 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.
    
    
    

PAST RESEARCH

1. DEMONSTRATION PROJECT:  VENTILATOR ASSOCIATED PNEUMONIA (VAP):  IMPROVING OUTCOMES THROUGH BEST PRACTICE IMPLEMENTATION. Contracted by a TriService Research Grant, ACE, BAMC, and Wilford Hall nurse teams developed, implemented, and evaluated impact of best practice in VAP.
   
   
2. EVIDENCE-BASED YOUTH SMOKING CESSATION. 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.
   
   
3. SURVEY OF PROGRAM NEEDS IN COLLEGE AGE SMOKERS. PI: Drs. Kathleen Stevens, Bill Spears, Manuel Oscos-Sanchez, and Marie Barron. This funded project surveyed college health directors and students to assess the college campus as a viable structure for offering smoking cessation programs to smokers ages 18 to 21. EBP interventions were woven into the project.
   
   
4.  SMOKING IN TEEN PREGNANCY. ACE Team. A major study focus was on the  special needs of pregnant, smoking teens. Teens have the highest rates of smoking among pregnant women. Maternal smoking is causally associated with 32,000 to 61,000 low-birthweight infants, 14,000 to 26,000 admissions to neonatal intensive care units, prematurity, and poor placental and fetal outcomes. Substantial direct medical costs in the range of $1.4 to $2 billion annually are attributable to smoking in pregnant women. Few smoking adolescents who attempt to quit on their own are successful. Effective smoking cessation treatment for pregnant teens is urgently needed. This project established the research evidence and best practices for smoking cessation programs with this group. ACE tested the efficacy of an innovative smoking cessation treatment designed specifically for pregnant teens. Also, ACE implemented and evaluated the outcomes of the intervention in terms of health status of mother and baby as well as healthcare costs.
    
   

5. DISSERTATION: PREGNANCY-RELATED FACTORS AND SMOKING STATUS IN PREGNANT HISPANIC ADOLESCENTS. PI: Dr. Laura Munoz. Connected to the Smoking in Teen Pregnancy project, this project examined the structure of factors between pregnancy and smoking in this population.
   
   

   STUDY DETAILS
   
   

• Teen Smoking
  
  
• Treating Tobacco Dependence
  
  
• Best Practice in Tobacco Treatment
  
  
• Smoking and Pregnancy
  
  
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