ch5rn169.pptx

Fundamentals of Nursing, 11th Edition Patricia A. Potter, RN, MSN, PhD, FAAN Anne Griffin Perry, RN, MSN, EdD, FAAN Patricia A. Stockert, RN, BSN, MS, PhD Amy Hall, RN, BSN, MS, PhD, CNE  Chapter 5 Evidence-Based Practice The Need for Evidence-Based Practice (1 of...

Fundamentals of Nursing, 11th Edition Patricia A. Potter, RN, MSN, PhD, FAAN Anne Griffin Perry, RN, MSN, EdD, FAAN Patricia A. Stockert, RN, BSN, MS, PhD Amy Hall, RN, BSN, MS, PhD, CNE  Chapter 5 Evidence-Based Practice The Need for Evidence-Based Practice (1 of 12)  Evidence-based practice (EBP)  Problem-solving approach to clinical practice that combines the best evidence with a clinician’s expertise, patient preferences and values, and health care resources in making decisions about patient care  The best scientific evidence comes from well- designed, systematically conducted research studies found in scientific, peer-reviewed journals. 3 The Need for Evidence-Based Practice (2 of 12) 4 The Need for Evidence-Based Practice (3 of 12)  Steps of evidence-based practice  0. Cultivate a spirit of inquiry.  1. Ask a clinical question in PICOT format.  2. Search for the best evidence.  3. Critically appraise the evidence.  4. Integrate the evidence.  5. Evaluate the outcomes of practice decision or changes.  6. Communicate the outcomes of the evidence-based practice decision. 5 The Need for Evidence-Based Practice (4 of 12)  Cultivate a spirit of inquiry  Constantly questioning current practices leads to consistent use of EBP.  EBP institutions demonstrate a culture in which nurses are encouraged to question practices. 6 The Need for Evidence-Based Practice (5 of 12)  Ask a clinical question in PICOT format:  P = Patient population of interest  I = Intervention of interest  C = Comparison of interest  O = Outcome  T = Time 7 The Need for Evidence-Based Practice (6 of 12)  Search for the best evidence  Sources include Agency policy Procedure manuals Quality improvement data Existing clinical practice guidelines Journal articles.  Ask experts for help Nurses Educators Librarians 8 The Need for Evidence-Based Practice (7 of 12) 9 The Need for Evidence-Based Practice (8 of 12)  Critically appraise the evidence  After critiquing all articles for a PICOT question: Synthesize or combine the findings Consider the scientific rigor of the evidence and whether it has application in practice  Use a systematic approach Determine the value, feasibility, and usefulness of evidence. 10 The Need for Evidence-Based Practice (9 of 12)  Integrate the evidence  Apply the research in your plan of care for a patient; use evidence as rationale.  Education about the change must occur.  Large-scale change requires planning.  Pilot study can show if change can be implemented easily.  Incorporate into policies and procedures.  Integration: teaching tools, clinical practice guidelines, P&Ps, new assessment tools 11 The Need for Evidence-Based Practice (10 of 12)  Evaluate the outcomes of the practice decision or change  When evaluating an EBP change determine: Was the change effective? Are modifications needed? Should the change be discontinued?  Unexpected events or results may occur.  Never implement a practice change without evaluating its effects. 12 The Need for Evidence-Based Practice (11 of 12)  Communicate the outcomes of the evidence- based practice decision  Clinical staff on the unit  Nursing practice council, EBP council, research council  Clinicians  Clinical grand rounds  Professional conferences and meetings 13 The Need for Evidence-Based Practice (12 of 12)  Sustain knowledge use  Incorporate the change into the culture and practice environment.  Use targeted strategies to sustain use of EBP decisions.  Employ transformational leadership. 14  Scientific Method (1 of 2)  Make an observation  Ask questions and gather information  Analyze the literature and form a research question or hypothesis  Conduct a study using scientific rigor  Analyze the date and draw conclusions 15  Scientific Method (2 of 2)  Types of research studies  Quantitative research Experimental research Nonexperimental research Surveys  Qualitative research Inductive reasoning 16  Nursing Research (1 of 4)  A way to identify new knowledge, improve professional education and practice, and use resources effectively  Many professional and specialty nursing organizations support the conduct of research for advancing nursing science. 17  Nursing Research (2 of 4)  Translation research phases  Preclinical and animal studies—basic science research  Phase 1 clinical trials—testing safety and efficacy in a small group of human subjects  Phase 2 and 3 clinical trials—testing safety and efficacy in a larger group of human subjects and testing for comparison to standard treatment  Phase 4 clinical trials and outcomes research— translation to practice  Phase 5 population-level outcomes research— translation to community 18  Nursing Research (3 of 4)  Outcomes research  Helps patients, health care providers, and those in health care policy make informed decisions on the basis of current evidence.  Typically focuses on the benefits, risks, costs, and holistic effects of a treatment on patients.  Outcomes must be observable or measurable.  Researchers need to select appropriate outcomes when designing their studies. 19  Nursing Research (4 of 4)  The conduct of nursing research  You may observe nurses performing research within your health care agency.  Nursing research allows you to study nursing questions and problems in greater depth within the context of nursing. 20  Performance Improvement  A formal approach for the analysis of health care–related processes  Reviews how existing interventions within a process function  PI combined with EBP is the foundation for excellent patient care and outcomes.  Performance improvement programs focus on processes or systems that significantly contribute to outcomes 21  The Relationship Among EBP, Research, and PI (1 of 2)  Although EBP, research, and PI are closely related, they are separate processes.  EBP: Use of information from research and other sources to determine safe and effective nursing care with the goal of improving patient care and outcomes  Research: Systematic inquiry answers questions, solves problems, and contributes to the generalizable knowledge base of nursing; may or may not improve patient care  QI: Improves local work processes to improve patient outcomes and health system efficiency; results usually not generalizable 22 The Relationship between EBP, Research, and QI (2 of 2) 23