NURS3030 Week 1 Chapter 1: Evidence-Based Practice PDF

Chapter 1 Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry Copyright © 2023 Wolters Kluwer All Rights Reserved Learning Objectives ❖Discuss how evidence-based practice (EBP) assists hospitals and healthcare systems achieve healthcare’s q...

Chapter 1 Making the Case for Evidence-Based Practice and Cultivating a Spirit of Inquiry Copyright © 2023 Wolters Kluwer All Rights Reserved Learning Objectives ❖Discuss how evidence-based practice (EBP) assists hospitals and healthcare systems achieve healthcare’s quadruple aim. ❖Describe the difference among EBP, Research, quality improvement, and evidence-based quality improvement. ❖Identify the seven steps of EBP ❖Discuss Barriers to EBP and key facilitators, including elements of cultures that support the implementation and sustainability of EBP. Copyright © 2023 Wolters Kluwer All Rights Reserved What is Evidence Based Practice in Nursing? + Copyright © 2023 Wolters Kluwer All Rights Reserved Evidence Based Practice ❖A problem-solving approach to the delivery of health care combines best evidence from research studies, patient care data, clinician expertise and patient preferences and values. ❖The highest quality of care and best patient outcomes can be achieved. …in Nursing Copyright © 2023 Wolters Kluwer All Rights Reserved EBP Enhances The Patient Experience ❖Better healthcare quality and safety ❖Improves patient outcomes ❖Reduces costs ❖Empowers nurses which improves their work lives Copyright © 2023 Wolters Kluwer All Rights Reserved Problem solving approach to clinical practice that integrates… ❖External Evidence- Evidence that is generated from rigorous research. ❖Evidence Based Theories- A theory that has been tested and supported through the accumulation of evidence from several studies. ❖Opinion Leaders- Individuals who are typically highly knowledgeable and well respected in a system; as such they are often able to influence change. ❖Expert Panels-Groups of individuals with specialized knowledge or expertise in a particular field who are brought together to discuss, evaluate, or provide recommendations on a specific topic or issue. Copyright © 2023 Wolters Kluwer All Rights Reserved Evidence-Based Decision Making ❖ Figure 1.1: Evidence-based decision making and practice facilitates healthcare’s quadruple aim. (From Melnyk, B. M., & Fineout-Overholt, E.. Evidence-based practice in nursing & healthcare. A guide to best practice. Wolters Copyright © 2023 Wolters Kluwer All Rights Reserved Seven-Step Process of EBP The Seven Steps of EBP Incorporating the EBP Steps to Create EBQI 0. Develop a spirit of inquiry within an EBP Plan culture and environment. 1. Ask the question in PICOT format. 2. Systematically search for and collect the most relevant best evidence. 4. Integrate the best evidence with Do clinician expertise and patient-/family- valued preferences to make the best clinical decision. 5. Evaluate the outcome(s) of a practice Study decision or change based on evidence. 6. Disseminate the outcome(s). Act ❖ Adapted from Melnyk B. M., Buck J., & Gallagher-Ford L. (2015). Transforming quality improvement into evidence-based quality improvement: A key solution to improve healthcare outcomes. Worldviews on Evidence- based Nursing, 12(5), 251–252. https://doi.org/10.1111/wvn.12112 Copyright © 2023 Wolters Kluwer All Rights Reserved Outcomes Management 1 Define clinical outcome that needs to be improved using current measurement within an organization. 2 Identify practices or processes supported by evidence to implement that will improve the outcome. 3 Compare evidence-based practices with traditional in-place practices and identify how to change practices based on this evaluation. 4 Analyze impact of implementing new practices by remeasuring targeted outcome and comparing outcomes before and after implementation. Copyright © 2023 Wolters Kluwer All Rights Reserved Types of Evidence Used in EBP Copyright © 2023 Wolters Kluwer All Rights Reserved Question #1 ❖Is the following statement true or false? ❖Finding a research study that tests a protocol for turning immobile patients published in a peer- reviewed journal is an example of external evidence. Copyright © 2023 Wolters Kluwer All Rights Reserved QI versus EBQI Quality Improvement (QI) Evidence-Based Quality Improvement (EBQI) Relies primarily on internal Begins with internal evidence evidence Often does not involve systematic Includes external evidence in search for and critical appraisal of decision making about identifying evidence that guides what and process changes that will impact how what is done the practice change to improve a clinical outcome Goal to become EBQI by incorporating the four “Plan” steps from the EBP process Copyright © 2023 Wolters Kluwer All Rights Reserved Question #2 ❖Which of the following involves bringing the body of evidence together with clinical expertise and patient preferences and values to identify best practice? A. Evidence-based practice B. Research C. Translational research D. Research utilization E. Evidence-based quality improvement Copyright © 2023 Wolters Kluwer All Rights Reserved Key Influencers for Advancing EBP #1 ❖IOM’s Roundtable o Accelerating the progress toward a learning healthcare system, in which evidence is applied and developed as a product of patient care. o Generating evidence to support which healthcare strategies are most effective and produce the greatest value. o Improving public awareness and understanding about the nature of evidence and its importance for their healthcare Copyright © 2023 Wolters Kluwer All Rights Reserved Key Influencers for Advancing EBP #2 ❖Federally funded initiatives: o U. S. Preventive Services Task Force (USPSTF) o Community Services Task Force o Patient-Centered Outcomes Research Institute (PCORI) Copyright © 2023 Wolters Kluwer All Rights Reserved Key Influencers for Advancing EBP #3 ❖Magnet Recognition Program o Transformational leadership o Structural empowerment o Exemplary professional practice o New knowledge, innovation, and improvements o Empirical quality results Copyright © 2023 Wolters Kluwer All Rights Reserved Key Influencers for Advancing EBP #4 ❖ Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare o Prepares interprofessional EBP experts/mentors through 5-day immersions and postdoctoral fellowship program. o Works with nursing and transdisciplinary faculty across the nation and world to integrate EBP throughout curricula to produce the highest caliber of evidence-based graduates. o Educates nursing/transdisciplinary students at all levels to access the latest gold standards of care and implement/sustain EBP. o Provides consultations and assists leaders/transdisciplinary clinicians in hospitals/healthcare systems to advance and sustain evidence-based care to reach the quadruple aim. Copyright © 2023 Wolters Kluwer All Rights Reserved Key Influencers for Advancing EBP #5 ❖ Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare (cont.) o Conducts national webinars on best and latest evidence to guide high-quality practice. o Serves as a clearinghouse for best evidence on a variety of healthcare practices and health conditions for the public. o Conducts research to advance the body of knowledge regarding EBP and how to accelerate the translation of research findings into practice more rapidly to improve outcomes. o Provides an implementation toolkit based on ARCC model Copyright © 2023 Wolters Kluwer All Rights Reserved Question #3 ❖Is the following statement true or false? ❖Although organizational culture and context are important, they are not necessary for evidence- based practice to be implemented and sustained in the organization. Copyright © 2023 Wolters Kluwer All Rights Reserved Question #4 ❖Is the following statement true or false? ❖According to Melnyk & Fineout-Overholt, there are six steps to the evidence-based practice process. Copyright © 2023 Wolters Kluwer All Rights Reserved Barriers and Facilitators to Evidence- Based Practice ❖Within healthcare organizations and settings where care is provided, both barriers and facilitators exist that influence the uptake and sustainability of EBP. ❖Practitioners must learn how to overcome barriers and leverage facilitators in order to implement EBP. ❖Organizational barriers, facilitators, culture, and readiness for system-wide implementation of EBP should be assessed. Copyright © 2023 Wolters Kluwer All Rights Reserved Examples of Barriers to EBP ❖Lack of EBP knowledge and skills ❖Cultures steeped in tradition ❖Misperceptions or negative attitudes about research and evidence-based care ❖Lack of beliefs that EBP will result in more positive outcomes than traditional care and the ability to deliver it ❖Voluminous amounts of information in professional journals ❖Lack of time and resources to search for and critically appraise evidence Copyright © 2023 Wolters Kluwer All Rights Reserved Examples of Facilitators of EBP ❖A culture that makes EBP the standard or norm ❖Support and encouragement from leadership/administration that foster an EBP culture with expectations for EBP ❖Alignment of stakeholders ❖Time to critically appraise studies and implement findings ❖Clearly written research reports ❖EBP mentors with excellent EBP skills as well as knowledge and proficiency in individual and organizational change strategies Copyright © 2023 Wolters Kluwer All Rights Reserved Strategies to Eliminate Barriers to Using Evidence-Based Practice ❖Assess barriers and facilitators and readiness for implementation ❖Conduct surveys or focus groups with clinicians to assess baseline knowledge, beliefs, and behaviors regarding EBP ❖Objectively document the status of EBP to demonstrate change in outcomes ❖Expose those without buy-in to real-case scenarios ❖Correct misperceptions about EBP Copyright © 2023 Wolters Kluwer All Rights Reserved Question #5 ❖ Scenario: EBP is identified as a core value in our organization’s new strategic plan. This plan includes making sure all policies are supported by evidence within 3 years. In order to accomplish this, units begin hosting unit-based journal clubs from noon until 1 p.m. once a week to teach advanced critical appraisal skills. Staff are permitted to attend if census and staffing ratios allow. ❖ Which of the following is the barrier in the scenario above? A. Having a new strategic plan B. The plan goal of making sure all policies and procedures are supported by evidence within 3 years C. Hosting unit-based journal clubs D. The timing and stipulations for attendance of the unit- based journal clubs Copyright © 2023 Wolters Kluwer All Rights Reserved Step 0-The Spirit of Inquiry ❖In patients with head injuries, how does supine positioning compared with elevating the head of the bed 30 degrees affect intracranial pressure? ❖In patients with supraventricular tachycardia, how does administering the β-blocker metoprolol (Lopressor, Toprol-XL) compared with administering no medicine affect the frequency of tachycardic episodes? ❖What do you want to know???? ❖Without this spirit of inquiry, the next steps in the EBP process are not likely to happen Copyright © 2023 Wolters Kluwer All Rights Reserved ❖Case Scenario for EBP: Rapid Response Teams You’re a staff nurse on a busy medical–surgical unit. Over the past three months, you’ve noticed that the patients on your unit seem to have a higher acuity level than usual, with at least three cardiac arrests per month, and of those patients who arrested, four died. Today, you saw a report about a recently published study in Critical Care Medicine on the use of rapid response teams to decrease rates of in- hospital cardiac arrests and unplanned ICU admissions. Copyright © 2023 Wolters Kluwer All Rights Reserved ❖The study found a significant decrease in both outcomes after implementation of a rapid response team led by physician assistants with specialized skills. 9 You’re so impressed with these findings that you bring the report to your nurse manager, believing that a rapid response team would be a great idea for your hospital. The nurse manager is excited that you have come to her with these findings and encourages you to search for more evidence to support this practice and for research on whether rapid response teams are valid and reliable. Copyright © 2023 Wolters Kluwer All Rights Reserved VIDEO: Be Curious: Advancing the Nursing Profession Through Clinical Inquiry ❖John Hopkins: Spirit of Inquiry Video Copyright © 2023 Wolters Kluwer All Rights Reserved