EvidenceBased Practice

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Evidence-Based Practice

• Nursing

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Training in EBP for Nurses

• Advantages
• Ensure that patients receive best care.
• Mechanism to improve the quality of care.
• Part of change management within the
  organisation.
• Nursing Professional Development.
• Enhance communication with other health
  professionals.

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Strategies for Teaching EBP to Nurses

• Train the Trainers in EBP
• Introduction within under-graduate training and
  graduate year programs.
• Formulating research questions introduced within
  specific clinical contexts
• Computer searching and accessing evidence-based
  research introduced with the clinical ward
  environment.

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Short-course Introduction to EBP.

• Train the Trainers
• Introduction to the principles of EBP
• Formulating questions in a PICO format
• Database Searching
• MeSh Heaings
• Medline
• Cochrane
• Cinahl
• Introduction to systematic reviews,
  meta-analysis.
• Introduction to Evidence-Based Guidelines.

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Problems with EBP training

• Perceived as too time-consuming
• Question
• Applicability
• Relevance
• Practicality
• Nurses may not feel that they are in a position
  to change practice within their ward.
• Perception that robust high-level evidence for
  nursing interventions does not exist.

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Educational Strategies

• Train Nurses in Educational Leadership Roles.
• Incorporate summaries of the evidence into tools
  and documentation currently used within the ward
  area.
• Need for tool-kits that summarise the evidence.
• EG Delirium Management Guidelines
• Incorporate into educational sessions given to
  graduate year nurses.

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Need for Organisational Support for
Implementation ofEvidence-Based Care

• Example
• Non-invasive ventilation for management of
  hypercapnic respiratory failure secondary to
  exacerbation of COPD.
• Level II Evidence
• Safe alternative to Critical Care,
• Cost-effective,
• Decreased inpatient mortality.
• Keenan, S. 2003 Annuals of Internal Medicine,
• Plant, PK. 2003 BMJ.

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Respiratory Care Unit

• Not used at RMH outside critical care / high
  acuity beds before Sept 2004.
• Lack of staff expertise.
• Lack of equipment.
• No specialised beds
• Perception that use of NIV in general ward areas
  would be unsafe.
• Opening Respiratory Care Unit to provide an
  environment in which
• Non-invasive Ventilation could be used outside
  high-dependency areas.

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EBP and Quality Improvement

• EBP as part of the Quality Improvement Cycle
• Acknowledgement of projects that have improved
  practice quality of care.
• Raise awareness that implementation of high
  quality care is about implementing current
  evidence.

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Oxygen Therapy in Hypercapnic COPD patientsWhy
is this still a problem?How do we close the
quality and safety loop?
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System change

• Staff Education Program
• Patient Empowerment
• Identification of CO2 retainers
• Alert at ED triage, Second screen in ED and
  clinical pway
• Alert in front of history
• Coloured arm band in hospital
• Sign over bed
• Written oxygen order on RCU forms
• ?prescription of O2
• All patients with lung disease and ?CO2 reported
  to resp reg or CNC for resp med.

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Re-evaluation

• Repeat audit next year
• Hope to demonstrate ongoing change
• Important to demonstrate that implementation of
  evidence-based best practice requires input from
  all members of the multi-disciplinary team.
• One mechanism to increase a sense of ownership
  and involvement in improving care.

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EBP and Advanced Nursing Roles

• Development of Clinical Nurse Consultant and
  Clinical Nurse Practitioner Roles within the
  organisation.
• Need for focused interventions that improve
  patient outcomes.
• Need for interventions to be cost-effective.

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Development of Advanced Practice Roles

• Based upon systematic review of the literature.
• Identification of current best practice and
  evidence.
• Identification of gaps in the evidence.
• Support to formulate research to address gaps in
  the evidence.

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Summary

• World-wide EBP Education for Nurses is becoming
  standard practice.
• Need for EBP to become part of the nursing
  culture at Melbourne Health.
• Need for Applied Evidence for Nursing
  Interventions to be readily available in the
  clinical setting.
• Need for greater support for senior nurses to
  contribute to the development of evidence based
  practice for nurses.

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Evidence for Nursing Practice

• Nursing Literature
• Qualitative Quantitative Research
• Evidence-Based Clinical Practice Guidelines
• Medical Scientific Literature

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Interventions for Chronic Conditions
Controlled chronic disease
Established disease
Disease management and 3o prevention
Optimise HRQoL
Prevent acute exacerbations
Continuing care Maintenance Rehabilitation Self-
management
Treatment Management of complications
Specialist services Hospital care Primary care
Primary care Community care
Health Promotion
Health Promotion
N Spearing. University of Queens land
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Evaluating Program Effectiveness
.................Measuring Outcomes

• Individual Client outcomes
• Behavioural change
• Changes in quality of life
• Client carer satisfaction
• Systems-Based outcomes
• Re-admission rates
• Inpatient Length of Stay
• Adherence with follow-up
• Health Economic outcomes
• Cost-effectiveness
• Models of Cost Reduction

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