Evidence-Based Practice SG PDF

Evidence-Based Practice SG The use of the best scientific evidence integrated w/ ○ Clinical experience ○ Incorporating PT values and preferences in the practice of professional nursing EBP Process 1.) Ask the questio using PICOT 2.)...

Evidence-Based Practice SG The use of the best scientific evidence integrated w/ ○ Clinical experience ○ Incorporating PT values and preferences in the practice of professional nursing EBP Process 1.) Ask the questio using PICOT 2.) Collect relevant evidence to answer question 3.) Critically evaluate evidence a.) Reading the research article b.) Study design c.) Strength of evidence 4.) Integrate practice changes into the clinical setting by incorporating a.) Evidence b.) Clinical experience c.) PT preferences and values 5.) Evaluate the outcome of the practice change 6.) Disseminate the outcome through presentation or publication TEST QUESTION FROM THIS ^^^^^^^^^^ Asking The Question ○ What can be improved–cultivate a spirit of inquiry ○ Observe current practice ○ Review incidence reports ○ Watch nurse sensitive indicators National Database of NUrsing Quality Indicators (NDNQI) Falls HAPI’s CAUTIs CLABSIs ○ Identify the problem What do you want to know?  Developing the PICOT Question ○ P= Population/ PT or Problem ○ I= Intervention ○ C= Comparison of interventions or alternative to intervention ○ O= Outcome (desired effect) ○ T= Time Frame (optional) ○ EX of PICOT Question Among postoperative orthopedic patients (P), does hourly rounding (I) increase patient satisfaction ratings(O) related to nursing care? (C would be no intervention or patients with no hourly rounding protocol) In adult patients on a med-surg unit(P), does the utilization of a rapid response team (I) compared with no rapid response team (C), affect the number of cardiac arrests (O) over a 6-month period(T)? Collecting the Relevant Evidence ○ Use PICOT question as a guide ○ Conduct literature review from reliable sources NEEDS TO BE WITHIN LAST 5 YRS TO BE RELEVANT Peer reviewed articles Original research articles CINAHL (Cumulative Index to Nursing and Allied Health Literature) Medline (Comprehensive resources for National and International medical literature) Cochrane Library (systemic reviews) Clinical Practice GUidelines National Guideline Clearinghouse (NGC) Current Practice Guidelines in Primary Care (access medicine) Evaluating the Evidence: Reading the Resaerch Article ○ Title gives the main topic of the study ○ Abstract One paragraph summary of the entire study (What the article is about) ○ Introduction describes the topic under investigation and why it is worth studying Literature Review ○ summarizes or discusses relevant prior research ○ Methods details how the research was performed (survey numerical PT population) ○ Results describes the data that was collected and the results of any statistical tests that were performed Charts/tables ○ Conclusion/Discussion a summary of the results that were obtained in the study  ○ References – list of resources cited (for additional information) Evaluating the Evidence ○ Applicability Do the result apply to my sistuation/ population? Methods section Inclusion and exclusion criteria (who did they include/ exclude) Validity and Reliability Are the results valid and reliable enough to me to change practice? Results section ○ Describe data ad statistical tests Evaluating the Results ○ Validity Accuracy Does it measure what it is supposed to? ○ Reliability Consistency over time Will I get the same results if I use this research? Evaluating the Evidence Study Designs (I have no question write below this but I put it in here just in case) ○ Qualitative (feelings) Describes/promotes understanding of human experiences related to health in a non-numeric fashion Develops theory Designed for discovery Examples Grounded theory, Ethnography, Phenomenology ○ Quantitative (looks at numbers) Formal, objective, systematic process in which numeric data are used Tests theory Designed for verification Examples Survey, experimental, methodologic, controlled clinical trial, randomized controlled trial Qualitative Studies Examples (Testable) ○ What is the acceptance of bedside shift-report in med/surg nurses? Observation of practice on the unit ○ What are the experiences of fathers concerning support for their wives/partners during labor? Unstructured interviews with fathers ○ What is the experience of hope in women with advanced ovarian cancer? Semi-structured interviews with women with advanced ovarian cancer  Quantitative Studies Examples (Testable) ○ Measuring the association between nurse understaffing and medication error in hospitals Examining relationships between variables ○ Assessing the effectiveness of a new drug in comparison to placebo Experimental –introduces an intervention (drug) and studies the effects ○ Measuring the effect of crossing legs on blood pressure measurement Blood pressure measurements before and after crossing legs – resulting in numbers (data) 1 Evaluating the Evidence with Statistic ○ Measures of Central Tendency ○ Mean = Average value of the given data ○ Median = Middle value of the given data ○ Mode = Most repeated value in the given observations ○ Standard Deviation Shows how much variation there is from the mean Low = close to the mean High = values are spread out ○ THE COSER TO YOUR MEAN, THE MORE ACCURATE YOU ARE Evauating the Evidence: Strength of the Evidence (look for articles in top section) ○ Level I: evidence from a systematic review of all relevant randomized controlled trials (RCT), or evidence-based clinical practice guidelines based on systematic reviews of RCTs (most reliable/ the best to use) ○ Level II: evidence obtained from at least one well-designed Randomized Controlled Trial (RCT) ○ Level III: evidence obtained from well-designed controlled trials without randomization, quasi-experimental (own study) ○ Level IV: evidence from well-designed case-control and cohort studies ○ Level V: evidence from systematic reviews of descriptive and qualitative studies ○ Level VI: evidence from a single descriptive or qualitative study ○ Level VII: evidence from the opinion of authorities and/or reports of expert committees Integrating Practice Change into the Clincial Setting ○ Clinical experience/Expertise Evidence alone is never sufficient to make a clinical decision Clinical expertise means integrating the knowledge and information from patient care experiences and formal education as forms of evidence for making clinical decisions Evaluate the evidence in the context of clinical experience Important for PT Outcomes ○ Individual clinical expertise ○ PT values ○ PT expectations ○ Best available clinical evidence  Integrating Practice Change into the Clinical Setting ○ Patient Preferences and Values “The unique preferences, concerns and expectations each patient brings to a clinical encounter, and which must be integrated into clinical decisions if they are to serve the patient.” The beneficiary of EBP is the patient! Incorporating into EBP (have PT help/ work w/ PT) Explain the risks and benefits of a choice of interventions Employ a shared decision-making approach Mutually develop a plan of care Evauluate the Outcomes of the Practice ○ Evaluate for impact on patient outcomes ○ Begins at implementation (collect data as you go) ○ Monitor for Correct implementation Intended results Unexpected result Areas for improvement ○ If successful-modify policies and procedures to reflect new practice Disseminate the Outcomes (sharing) ○ Informally At agency level ○ Formally Presentation at national conferences Submission of articles for publication in professional journals EBP Committee ○ Serves as a “hub” for EBP and research activities at the facility ○ Helps coordinate and facilitate the use of best practice in the facility Influences policy, procedure, standards etc…… ○ Disseminates change throughout the organization ○ Provides opportunities for nursing involvement in research The AA Degree Nurse’s Role in EBP ○ Identify issues related to care Ask the clinical question ○ Explore available research on the issue ○ Implement practice changes ○ Continue evaluating ○ Participate Take part in Unit Practice Councils or EBP committees Slide 19 Said not testable but feel free to look over it!