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Evidence-Based Practice

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Title: Evidence-Based Practice


1
Evidence-Based Practice
  • An Independent Study Short Course for
    Medical-Surgical Nurses

2
  • This module was developed by the Clinical
    Practice Committee of the Academy of
    Medical-Surgical Nurses,
  • in accordance with
  • the 2006-2010 strategic plan.

3
Why is evidence-based practice important and why
now?
  • Changing patient demographics require new
    approaches to care.
  • The evidence base for practice is rapidly
    expanding and growing in complexity for nursing
    and other disciplines.

4
Why is evidence-based practice important and why
now?
  • How to search, evaluate, and apply evidence in
    practice is unknown by many or inconsistently
    used.
  • There continues to be a mismatch between what we
    know to be quality care and the quality of care
    that is delivered.

5
Why is evidence-based practice important and why
now?
  • Quality problems occur even in the hands of
    dedicated, conscientious professionals.
  • The burden of harm from the underuse, misuse, and
    overuse
  • of care is staggering.

6
Why is evidence-based practice important and why
now?
  • The 2003 report by the Institute of Medicine
    (Health Professions Education A Bridge to
    Quality) recommends that all health care
    professionals possess certain skills and
    competencies in order to enhance patient care
    quality and safety.
  • All health professionals should be educated to
    deliver patient-centered care as members of an
    interdisciplinary team, emphasizing
    evidence-based practice, quality improvement
    approaches, and informatics.
  • (Institute of Medicine, 2003)

7
Purpose of Module
  • To provide an overview of evidence-based practice
    (EBP), one of the five competencies that all
    health care professionals should possess
    (Institute of Medicine, 2003).
  • Where and how to find the best possible sources
    of evidence for your practice.
  • How to formulate clear clinical questions.
  • How to search for relevant answers to the
    questions.
  • Determine when and how to integrate these new
    findings into practice.

8
Objectives
  • At the end of this module, you will be able to
  • Recognize evidence-based practice (EBP) as one of
    five core competencies all health professionals
    should possess regardless of their title or
    discipline (Institute of Medicine, 2003) for
    crossing the quality chasm.
  • Define EBP.

9
Objectives
  • Identify two characteristics differentiating
    research utilization and EBP in nursing.
  • List three components of EBP.
  • Provide two examples of how EBP benefits the
    nurse.
  • Provide two examples of how EBP benefits the
    patient.

10
Objectives
  • Describe the 5 steps of the EBP process.
  • Write a researchable clinical question.
  • Identify resources for developing relevant
    answers to the question.
  • Use clinical judgment and the 5-step process for
    determining when and how to integrate findings
    into practice.

11
Evidence-Based Practice
  • is
  • Knowing that what we do is the best practice.

12
How do we know in nursing?
  • Tradition
  • Authority
  • Borrowing
  • Trial and error
  • Personal experience
  • Role modeling and mentorship
  • Intuition and reasoning
  • Nursing research

13
Nursing Research
  • Diligent, systematic inquiry to validate and
    refine existing knowledge and generate new
    knowledge that directly and indirectly influences
    nursing practice. (Burns Grove, 2004)

14
Types of Nursing Research
  • Describe
  • Identify and understand phenomena, issues
  • Explain
  • Clarify relationships
  • Predict
  • Estimate the probability of outcome
  • Control
  • Manipulate the situation to get desired outcomes

15
  • Much of what is known from research has not been
    applied in practice.
  • This is known as

Research-Practice Gap
16
Research-Practice Gap
  • During the 1980s and 1990s, nursing emphasized
    bridging this research-practice gap through the
    development of research utilization (RU)
    projects.

17
Research-Practice Gap
  • Steps of the process included
  • Dissemination of knowledge.
  • Synthesis of findings.
  • Critique of studies.
  • Application of findings.
  • Development of research-based practice guidelines
    (i.e., Agency for Health Care Policy and
    Research/AHCPR practice guidelines Conduct and
    Utilization of Research in Nursing/CURN practice
    protocols).

18
Research-Practice Gap
  • Even though guidelines and knowledge have been
    disseminated, the overall effect on clinical
    practice and patient outcomes is unclear.

19
Research-Practice Gap
  • The problems of importance to medical-surgical
    nursing (skin breakdown, pain, bowel function,
    treatment adherence, nausea) and related
    interventions are largely not collected in
    medical record databases.
  • Nursing research studies are predominately
    descriptive or qualitative in design, rather than
    what is considered more rigorous and
    quantitative.

20
EBP is
  • Needed to help bridge the research-practice gap
    by
  • Strengthening the evidence base so that we know
    what works and what doesnt work in providing
    patients with the best outcomes.
  • Standardizing evidence across fields to reach the
    best outcome for the patient.
  • Housing evidence in online databases providing
    reviews of the evidence base.
  • Translating and consolidating state of the
    science into clinical recommendations.
  • (Stevens, 2004)

21
EBP is
  • Conscientious, explicit, and judicious use of
    theory-driven, research-based information in
    making decisions about care delivery to
    individuals or a group of patients, and in
    consideration of individual needs and preferences
    (Ingersoll, 2000).

22
EBP is
  • Integration of best research evidence, clinical
    expertise, and patient values in making decisions
    about the care of individual patients (Institute
    of Medicine, 2001).

23
Key Components of EBP
  • Decisions about care are based on
  • A. Research evidence.
  • B. Clinical expertise, judicious use.
  • C. Patient values and circumstances.
  • (Institute of Medicine, 2003)

24
A. Research Evidence
  • Randomized controlled trials
  • Laboratory experiments
  • Clinical trials
  • Epidemiological research
  • Outcomes research
  • Qualitative research
  • Expert practice knowledge, inductive reasoning

25
B. Clinical Expertise
  • Knowledge gained from practice over time
  • Inductive reasoning

26
C. Patient Values, Circumstances
  • Unique preferences
  • Concerns
  • Expectations
  • Financial resources
  • Social supports

27
Benefits for Med-Surg Nurses
  • Fewer Errors Reduced likelihood of making type
    1 and type 2 errors in practice
  • Type 1 Acceptance of a practice that is
    incorrect. Example Administration of a wrong
    dose, using the wrong procedure, teaching
    patients using the wrong information.
  • Type 2 Rejection of a practice that is correct.
    Example Failing to screen patients for fall or
    pressure ulcer risks failing to wash hands
    before and after patient contact failing to
    provide patients with smoking cessation
    information.
  • (Aherns, 2005)

28
Benefits for Med-Surg Nurses
  • Greater professional satisfaction from working
    as part of a team and experiencing effective
    practice.

29
Benefits for Med-Surg Nurses
  • Better Care
  • Less variation in care among caregivers where
    knowledge for improvement is already available.
  • More predictable health outcomes.
  • Less waste and inefficiency yielding fewer delays
    in diagnosis and treatment and fewer
    complications.

30
EBP Process
  • There are 5 steps in judging the evidence and
    determining the circumstances and patient values
    for guiding application.

31
EBP Process
The EBP Process Steps are
  • Assess practice (formulate question)
  • What isnt working?
  • What do you want to know about?
  • Decide (evidence review)
  • What resources are available and are they any
    good?
  • What has worked in other places?
  • How can you change your practice?
  • Plan (develop a plan based on findings)
  • Make a plan to change care based on relevant,
    applicable information.
  • Let others help.
  • Intervene (take action to review process or
    change)
  • Implement revised caregiving protocol in
    clinical unit.
  • Evaluate (care improved or modify and again
    intervene)
  • How well is that working for you?

32
References
  • Aherns, T. (2005). Evidence-based practice
    Priorities and implementation strategies. AACN
    Clinical Issues. 16(1), 36-42.
  • Burns, N. Grove, S. K. (2004) The Practice of
    Nursing Research Conduct, Critique
    Utilization, 2-3.
  • Fineout-Overholt, E., Melnyk, B.M., Schultz, A.
    (2005). Transforming health care from the inside
    out Advancing evidence-based practice in the
    21st century. Journal of Professional Nursing,
    21(6), 335-344.
  • French, B. (2005). Evaluating research for use in
    practice what criteria do specialist nurses use?
    Journal of Advanced Nursing, 50(3), 235-43
  • Ingersoll, G. I. (2000). Evidence-based Nursing
    What it is and what it isnt, Nursing Outlook,
    48, 151-152
  • Institute of Medicine,(US) Committee on Quality
    Healthcare in America (2001). Crossing the
    quality chasm A new health system for the 21st
    Century, The National Academies Press, 145-163
  • Institute of Medicine, (US)Greiner, A. Knebel,
    E., (Eds.) (2003) Health Professions Education A
    bridge to quality, The National Academies Press,
    45-74
  • Ledbetter, C. A, Stevens, K.R. (2000). Basics
    of Evidence-Base Practice, Seminars in
    Perioperative Nursing 9 (3) 91-97
  • National Patient Safety Goals. (2006). The Joint
    Commission (formerly JCAHO)
  • Stevens, K. R. (2004). ACE Star Model of EBP
    Knowledge Transformation. Academic Center for
    Evidence-based Practice. The University of Texas
    Health Science Center at San Antonio.
    www.acestar.uthscsa.edu

33
Additional Readings
  • Cullen, L., Greiner, J., Greiner, J., Bombei, C.,
    Comried, L. (2005). Excellence in
    evidence-based practice Organizational and unit
    exemplars. Critical Care Nursing Clinics of
    North America, 17, 127-142.
  • Greiner, A., Knebel, E., (Eds.). (2003). Health
    professions education A bridge to quality.
    Washington, DC The National Academies Press.
  • Stevens, K.R., Staley, J.M. (2006). The
    Quality Chasm reports, evidence-based practice,
    and nursings response to improve healthcare.
    Nursing Outlook, 54(2), 94-101.
  • Titler, M., Kleiber, C., Steelman, V., Goode, C.,
    Rakel, B., Barry-Wlker, J., et. al. (1994).
    Infusing research into practice to promote
    quality care. Nursing Research, 43, 307-313.
  • Titler, M., Kleiber, C., Steelman, V., Rakel, B.,
    Budreau, G., Everett, L., et. al. (2001). The
    Iowa Model of evidence-based practice to promote
    quality care. Critical Care Nursing Clinics of
    North America, 13(4), 497-509.
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