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Application of Research into Practice: Using Evidence-Based Practice


Application of Research into Practice: Using Evidence-Based Practice T. Heather Herdman, RN; PhD Executive Vice President Matousek & Associates, Inc. – PowerPoint PPT presentation

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Title: Application of Research into Practice: Using Evidence-Based Practice

Application of Research into Practice Using
Evidence-Based Practice
  • T. Heather Herdman, RN PhD
  • Executive Vice President
  • Matousek Associates, Inc.

Research in Practice
  • Evidence-based practice
  • A problem solving approach to practice that
    involves the conscientious use of current best
    evidence in making decisions about patient care

Problem-Solving Approach
  • Incorporates
  • Systematic search for and critical appraisal of
    the most relevant evidence to answer a burning
    clinical question
  • Ones own clinical expertise
  • Patient preferences and values

Why Evidence-Based Practice?
  • If your child was born prematurely, would you
    want her healthcare providers to give you
    information about how other parents have coped
    with parenting a preterm infant, based on
    evidence from well-designed qualitative and/or
    descriptive studies?
  • If your mother was diagnosed with breast cancer
    and needed to decide what type of treatment to
    choose, would you want to know the evidence
    regarding the risks and benefits of each
    treatment option as determined from clinical
    trials with other similar cancer patients?
  • If you were in a car crash and were paralyzed,
    would you want to know and use the most
    effective, empirically supported treatment
    established through randomized controlled trials
    to increase your chances of regaining mobility
    and sensation?

Clinical Decision Making
  • Health care professionals face complex decisions
    daily regarding patient careand must do so with
    decreased resources (less staffless money for
    equipment and suppliesless TIME!!!)
  • What is an appropriate outcome for this patient?
  • What intervention is most effective for getting
    this patient to meet that outcome?
  • What is the most efficient method for providing
    appropriate care for this patient?

Research Practice Gap
  • Evidence indicates that patients receiving care
    based on most up-to-date information from
    research studies experience 28 better outcomes
    than those patients receiving non-research based
  • Only a small percentage of healthcare providers
    incorporate research findings into patient care
  • Melnyk Fineout-Overholt (2005)

Research Practice Gap
  • It can take as long as 17 years to translate
    research findings into practice
  • How many lives are lost?
  • How many unnecessary hospitalizations?
  • How many ineffective treatments?
  • How much unnecessary cost?
  • How much time wasted out of your work day?

Patient Satisfaction
  • There is some evidence to indicate that
    healthcare providers using evidence-based
    practice receive higher patient satisfaction
    scores that those who do not
  • Provides more ability for nurses to control their
    own practice
  • Increases nurse morale
  • Decreases nurse turnover

Key Steps of Evidence-Based Practice
  • Ask the burning question (PICO format whenever
  • Patient population of interest
  • Intervention of interest/Interest area
  • Comparison of interest
  • Outcome of interest
  • Collect the most relevant and best evidence to
    answer the clinical question

Key Steps of Evidence-Based Practice
  • Critically appraise the evidence for its
    validity, relevance and applicability
  • Integrate the evidence with ones own clinical
    expertise, assessment of patient condition
    available healthcare resources, along with
    patient preferences and values to implement a
    clinical decision
  • Evaluate the change resulting from implementing
    evidence into practice

Barriers to Evidence-Based Practice
  • Im a practitioner not a researcher!
  • Lack of knowledge regarding EBP strategies
  • Misperceptions/negative views about research
  • Lack of time and resources to look for, read,
    critique and implement research
  • Peer pressureWeve always done it this way
  • Too much information to process
  • Lack of belief that EBP can improve outcomes of

Facilitators of Evidence-Based Practice
  • Support/encouragement from administration
  • Time to critically appraise studies and implement
    their findings
  • Clearly written research reports
  • Implementation infrastructure
  • Shared vision/mission within the healthcare team
  • Credibility of the research/guidelines

Questioning Clinical Practice
  • Encourage clinicians to ask questions about their
    clinical practice (rather than penalize them for
    being difficult!!!)
  • Does sucrose decrease pain in neonates?
  • Does nonnutritive sucking decrease pain in
  • Does kangaroo care decrease pain in neonates?
  • Which of these treatments is most effective?
  • Is one more effective than the others?
  • What does a cost-benefit analysis show when
    comparing one treatment to the other?
  • Can we make a good clinical case for one
    treatment over the other?

Questioning Clinical Practice
  • Encourage a reflective, inquiring approach in all
    professional and assistive staff
  • Asking the right questions
  • takes as much skill
  • as giving the right answers!
  • Robert Half

Questioning Clinical Practice
  • Use staff meetings more effectively to discuss
    key areas of clinical practice
  • How do patients respond to interventions being
  • Are there alternative treatments you can think of
    that might have a better impact?
  • Are there things that you find really
    dissatisfying about your practice?
  • What things cause patients the most

Questioning Clinical Practice
  • Identify staff that are responsible for scanning
    research literature on certain topics and
    bringing in new articles for clinical practice
  • Consider research taking place in other clinical
    practice settings
  • Look to the Centers for Evidence-Based Practice
    that exist around the world
  • Germany, New Zealand, Australia, United Kingdom,
    United States, Canada

Adopting Practice Change
  • Critique and synthesize research studies and
    evidence-based clinical practice guidelines
  • Team up with academicians
  • Find win-win situations for practice settings and
    university settings
  • Decide whether or not findings should be
    implemented into practice in your setting, given
    your organizations resources and patient

Adopting Practice Change
  • Consider
  • How relevant is the research to practice?
  • Are the findings consistent across studies?
  • Are there adequate studies and/or sample sizes to
    make the findings meaningful?
  • Is this change practical for your setting?
  • What is the risk of harm for the patients and how
    does that compare to the potential benefit for

Developing EBP Protocols or Guidelines
  • Protocols or Guidelines provide
  • Comfort for practitioners that the practice
    changes are based on evidence versus opinion or
    cost factors
  • The level of evidence available on the topic
  • Guidance on how to implement the practice change,
    and what parts of that change are based on what
    level of evidence

Implementing Practice Change
  • Diffusion of an innovation
  • Nature of the innovation
  • Manner in which it is communicated to healthcare
  • Barriers include
  • Conflicting research results
  • Research reports that are hard to understand
  • Lack of compilation of research evidence
  • Lack of providers knowledgeable about research

Changing Clinical Practice
  • Results of 44 systematic reviews focused on the
    effectiveness of strategies to change practice of
    healthcare professionals
  • Passive dissemination of research is ineffective
  • Range of interventions found effective in
    changing behaviors
  • Multifaceted interventions more likely to be
    effective than single intervention
  • Individual provider beliefs, attitudes
    knowledge impact behaviors but organizational,
    economic and community environments are also
  • Diagnostic analysis should be done to identify
    barriers and supportive factors likely to
    influence proposed changes in practice
  • Successful strategies to change practice need to
    be adequately resourced and require people with
    appropriate knowledge and skills

Strategies for Changing Clinical Practice
  • One-on-one sessions with health care educators
    and staff to explain desired change
  • Manual computerized reminders to prompt
    behavior change
  • Educational meetings or in-services requiring
    active participation of learners
  • Computerized information sources that are
    interactive in nature
  • Audits feedback in which clinical performance
    is monitored through electronic database or chart
  • Direct observation and feedback

  • EBP is critical if we are to provide the best
    care at the right time and at the lowest cost
  • Efficiency
  • Effectiveness
  • Best outcome