Nursing: A Concept-Based Approach to Learning, 2nd Edition

Module 45 Evidence-Based Practice  The Concept of Evidence-Based Practice Evidence-based practice (EBP) ( nurses make clinical decisions based on best research evidence, their clinical expertise, and healthcare preferences of their clients Aim ( to provide best possible care based on best available research (caring sets nursing apart as a most trusted profession) Push for EBP ( Institute of Medicines 2000 report To Err Is Human Neither healthcare environment nor EBP is static Sigma Theta Tau International Honor Society of Nursing EBP ( an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families and communities who are served Evolution of evidence-based practice Early 1970s, Dr. Archie Cochrane campaigned healthcare providers to use evidence when making healthcare decisions 1996, Dr. David Sackett gave a commonly accepted definition of EBP The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient Translational research is emerging as a systematic approach of converting research knowledge into applications of health care for improved client outcomes See CONCEPTS RELATED TO EBP, p. 2585 Benefits of evidence-based practice Ability to access/use evidence from a variety of sources that will help improve client care Ensures credibility of the nursing profession Provides accountability for nursing care Nursing clinical research Nursing research ( a systematic and strict scientific process that test hypotheses about health-related conditions and the processes of nursing care Nursing clinical research ( seeks answers to questions that will ultimately improve client care Quantitative research ( uses precise measurement to collect data and to analyze it statistically for a summary and description of resulting findings Qualitative research ( investigates a question through narrative data that explores the subjective experiences of human beings and can provide nursing with a better understanding of the clients perspective Funding Many sources of funding are available Ranges from small research grants from local professional nursing chapters to larger grants awarded by state or national foundations Participants Researchers develop a list of criteria for participants Research participants ( volunteers for a specific study that meet all inclusion criteria, have been informed of all aspects of the study, and have signed informed consent Ethical and legal issues Respect for human dignity requires that researchers ensure the volunteers are participating freely in a study without coercion and after receiving full disclosure of the study and the potential risks involved Beneficence requires that researchers protect participants from physical injury, psychological harm, economic insult and exploitation during or as a result of the study Justice is the fair treatment of all participants HIPAA includes a privacy rule Informed consent ( includes the right to receive information as well as the right of participants to withdraw from the study at any time Implications for nursing practice Providing best evidence for EBP Supporting nursing as a professional discipline Defining current best practice standards of nursing care Barriers to evidence-based practice Work schedule and workload demands Client preferences that might conflict with best practice care Lack of access to technology to find evidence when needed Limited knowledge in skills for finding and evaluating evidence Lack of experience and confidence in developing strategies to promote evidence-based care Lack of support from supervisors or agency personnel Lack of access to continuing education programs Attitudes of individual nurses Resistance to change from traditional client care routines Developing evidence-based practice Step 1 Develop a clinical question PICOT format ( See Table 452 Example of Clinical Question in PICOT Format p. 2589 Population Population attributes race, gender, etc. Issue of interest Treatments, education plan, etc. Comparison intervention Comparison group may not always exist Outcomes Quality of life, cost, etc. Time frame Case Study Part 1 ( Brent Calloway is the new nurse educator for a local hospitals medical-surgical division ,p. 2590 Step 2 Retrieve the evidence Best way to become proficient with literature searches ( visit different databases Choose the best terms to define Reference librarians good sources of information Several national/international nursing organizations develop/disseminate evidence-based resources Sigma Theta Tau International Honor Society for Nursing University of Texas Academic Center for Evidence-Based Practice Several others See Box 454, NURSING JOURNALS, p. 2591 Agency for Healthcare Research and Quality Established 14 evidence-based practice centers Centers review literature, synthesize evidence, help translate evidence-based research findings so more readily available Cochrane Database of Systematic Reviews Significant source of EBP data International not-for-profit organization Step 3 Evaluate the Evidence Evidence must be critically appraised for validity, reliability, and usefulness Validity ( the degree to which the study measured what it intended to measure Reliability ( its ability to produce consistent results with each use Measure the significance of the information gathered by rating the strength of the evidence to determine its validity and its relevance See Figure 45-3 HIERARCHY OF RESEARCH, p. 2591 Many organizations develop guidelines to provide their members with evidence-based information Stoplight used as analogy to demonstrate categories of evidence strength See Case Study Part 2 ( When Brent discussed with the vice president of his division the use of evidence to make decisions about changing training methods to improve client safety, she agreed it was a good idea , p. 2592 Step 4 Apply the Evidence Integrate best evidence into clinical practice Individual nurses can follow this process to identify best evidence for specific clinical questions Development process is similar to the nursing process EBP is a continuing process because new evidence replaces older evidence See Case Study Part 3 ( Evidence found by the group demonstrated that simulation was an effective method of learning for nurses , p. 2593 Strategies to implement evidence-based practice Assess yourself to determine how much of your present nursing practice is evidence based Assess the obstacles that inhibit you from using EBP more frequently Practice raising questions about current clinical practices and problem solving Acquire more information to correct your misperceptions about EBP Focus limited time on evidence from high-yield sources Go to AHRQ for free resource compilations of evidence reviews and practice guidelines on a wide range of topics Use the internet to cut down on time needed to find good evidence Learn how to do a critical appraisal of evidence Build your own awareness of how and why things are done Identify others interested in searching for evidence and evaluating it for collaborative opportunities Volunteer to participate on a quality nursing practice committee Participate in a research project Review The Concept of Evidence-Based Practice Relate Link the Concepts and Exemplars Refer Go to Nursing Student Resources Reflect Case Study 2015 by Education, Inc. Lecture Outline for Nursing A Concept-Based Approach to Learning, 2e, Volume 2 PAGE MERGEFORMAT 6 Y, dXiJ(x(I_TS1EZBmU/xYy5g/GMGeD3Vqq8K)fw9 xrxwrTZaGy8IjbRcXI u3KGnD1NIBs RuKV.ELM2fiVvlu8zH (W uV4(Tn 7_m-UBww_8(/0hFL)7iAs),Qg20ppf DU4p MDBJlC5 2FhsFYn3E6945Z5k8Fmw-dznZxJZp/P,)KQk5qpN8KGbe Sd17 paSR 6Q