Evidence-Based Practice PDF

Evidence- Based Practice NURS 1250/1610 Overview of Evidence-Based Practice Evidence-based practice (EBP): used to form a bridge between research and nursing practice Research: a formal systematic way of answering a question or approaching a problem Evidence: clinical knowledge, expert op...

Evidence- Based Practice NURS 1250/1610 Overview of Evidence-Based Practice Evidence-based practice (EBP): used to form a bridge between research and nursing practice Research: a formal systematic way of answering a question or approaching a problem Evidence: clinical knowledge, expert opinion, or information resulting from research Overview of Evidence- Based Practice Definitions of EBP include three components: Best evidence from the most current research available Nurse’s clinical expertise Patient preferences and values, which reflect: Why Evidence-Based Practice Reduce inappropriate variations in healthcare Standardization of safe, effective healthcare practices Improve safety and quality in healthcare Assist nurses in examining the “why” behind existing processes and procedures Observation is one of the most powerful tools in nursing practice Clinical expertise to improve patient outcomes Definitions Research- is obtaining information and objective facts to advance knowledge about a specific topic Nursing Research- is the use of systematic and strict scientific process to analyze phenomena of interest to all areas of nursing, including practice, education, and administration Nursing Clinical Research- seeks answers to questions that will ultimately improve patient care  Nursing Clinical Research Actively collaborate with healthcare team members to provide high quality care Help patient navigate the healthcare environment and assume many roles: Help ensure open and effective communication Benefits of EBP as a nurse? Nursing Clinical Research Example Questions Does early How does patient- What are the effects What is the effect of ambulation reduce centered care of music therapy on hourly rounding on the risk of deep vein influence recovery anxiety levels in the reduction of thrombosis in times in post- patients undergoing patient falls in orthopedic surgery operative patients? chemotherapy? hospital settings? patients? How does Does the use of mindfulness-based Do mobile apps for aromatherapy stress reduction medication improve sleep impact burnout reminders improve quality in patients among nurses adherence in elderly with chronic pain? working in intensive patients? care units? Nursing Clinical Researc h Clinical Nursing Research- Funding Funding for clinical research in nursing often comes from a variety of sources, each with its own priorities and processes. These funding sources include: Professional nursing organizations Corporations State agencies Federal organizations  Professional Nursing Organizations Key Role: American Nurses Association (ANA) National League for Nursing (NLN) Funding Characteristics: Research Grants & Scholarships Can support exploratory or pilot studies, doctoral research, or continuing education in research methods. Networking & Collaboration Provide networking opportunities to foster collaboration between researchers and nursing professionals. They may also fund collaborative research that aligns with their mission of improving healthcare and nursing practices. Focus Areas Patient safety, nursing education, workforce development, and clinical interventions. Corporations (Private Sector) Key Role: Pharmaceutical companies & medical device manufacturers Fund clinical trials, especially those related to new drugs, medical devices, or technologies Healthcare technology firms Fund research to improve healthcare delivery, cost-effectiveness, and patient outcomes through innovation in technology and service delivery models State Agencies Key Role: State health departments or state-level nursing boards fund research that addresses local health challenges, such as chronic diseases, infectious disease outbreaks, maternal and child health, or health disparities among different populations. Federal Organizations National Institutes of Health (NIH) The Agency for Healthcare Research and Quality (AHRQ), The Department of Veterans Affairs (VA) Funding Characteristics: Large-scale Research Grants Federal agencies offer substantial research funding through competitive grant programs. For example, NIH offers funding for clinical trials, basic science research, and nursing-specific studies through the National Institute of Nursing Research (NINR). Public Policy & Evidence- Based Practice Supports research that can influence national healthcare policies, improve clinical guidelines, and support the transition to evidence- based practices across the healthcare system Nursing Clinical Research: Participants Age, weight, gender, medical Researchers history develop list of Type, present state of disease criteria Present medications taken Categories of Inclusion criteria (acceptable) criteria for Exclusion criteria (not acceptable) participation Vulnerable Human fetuses populations Neonates, children subject to strict Prisoners legal, ethical Cognitively impaired individuals considerations Ethical and Legal Issues Research must adhere to three main ethical principles: Respect for persons (protect autonomy of individuals) Beneficence, nonmaleficence (protect participants from injury and harm) Justice (fair treatment of all participants) Ethical and Legal Issues Informed consent: Right to receive full disclosure, information regarding study Right to withdraw from study at any time Given in written form before the study begins Developing evidence-based practice Step 0 Cultivate and ignite a spirit of inquiry Step 1 Ask/ develop a clinical question Step 2 Retrieve the evidence Step 3 Evaluate the evidence Step 4 Apply the evidence Step 0: Ignite a spirit of inquiry “An ongoing curiosity about the best evidence to guide clinical decision making” Critical for embracing evidence-based practice! The “WHY” questions Note- this is not in your book!! Step 1: Develop/ Ask A Clinical Question Step 1: Develop/ Ask A Clinical Question Types of research studies Meta-analysis, Systematic reviews Randomized controlled trials (RCTs) Cohort studies (longitudinal studies) Case-control studies Case series, case studies Animal research See Nursing Issues- Supplemental Resources Spring 2025 Document for definitions Randomized controlled trials (RCTs) RCTs are a gold-standard experimental study design used to evaluate the effectiveness of interventions or treatments. Key characteristics include: Introduction of Treatment or Exposure: A specific treatment or exposure is introduced to study its effect on participants. Reduction of Bias: Methodologies such as randomization (assigning participants randomly to treatment or control groups) and blinding (concealing group assignments from participants and/or researchers) minimize potential biases. Comparison of Outcomes: They allow for direct comparison between groups, helping to determine the efficacy or safety of the intervention. Cause and Effect Evidence: As a controlled experiment, RCTs provide robust evidence of causal relationships between the intervention and the observed outcomes. Step 1: Develop/ Ask A Clinical Question Used to define and formulate a clinical question for EBP PICOT develops foreground questions that apply EBP to clinical situations (P) population (of patients) or (P) problem of interest (I) intervention, prognostic factor, or type of exposure (C) comparison/control of interventions or main alternative to intervention- includes no intervention (O) outcomes (desired effect) (T) timeframe (optional) Example: In patients with hypertension, does a low-sodium diet compared to standard dietary advice reduce blood pressure over six months? Step 1: Develop/ Ask A Clinical Question P: Patient, population, or problem I: Intervention C: Comparison intervention (may not always be present) O: Desired outcome T: Time (not always needed) You must always have a P, I, and O!! Using PICOT Statements P (Patient or Population, I (Intervention) Problem) What is the intervention or treatment What is the patient or group of you are considering? patients of interest? Using PICOT Statements C (Comparison, “control”) O (Outcome) Alternative intervention/ treatment? What is the effect (outcome) of the Not always required* intervention Using PICOT Statements T (Time) How much time does it take to demonstrate clinical outcomes? Not always required* Step 2: Retrieve the Evidence Once the question is formulated, the next step is to search for relevant evidence. This involves: Selecting appropriate databases: Examples include PubMed, CINAHL, Cochrane Library, and Google Scholar. Using keywords and Boolean operators: Combine search terms (e.g., "hypertension AND low-sodium diet"). Filtering results: Prioritize randomized controlled trials (RCTs). Step 2: Retrieve the Evidence F I LT E R E D R E S O U R C E S U N F I LT E R E D R E S O U R C E S What they are: These resources have been critically What they are: These resources contain original, raw appraised and summarized by experts. They provide high- research studies that have not been evaluated or quality evidence that's ready to use. summarized. Examples: Examples: Systematic reviews (e.g., Cochrane Reviews) Primary research articles (e.g., randomized controlled trials, Meta-analyses cohort studies) Case reports Evidence-based practice guidelines (e.g., NICE or WHO guidelines) Observational studies Benefits: Benefits: Save time because the evidence is already evaluated. Provide detailed, original data and findings. Provide the best, most reliable information. Allow you to conduct your own critical appraisal. When to use: When you need high-level, synthesized When to use: When filtered resources are unavailable or evidence for decision-making. when you need specific, in-depth data. Step 2: Retrieve the Evidence STEPS FOR SEARCHING RESOURCES: Identify the database or resource to use Identify keywords or subject headings (use your PICOT statement!) Search concepts separately and together using “Boolean Operators” using OR, AND Apply FILTERS to focus search results Analyze the number of results (your yield) Manually search your results (if Use abstracts, skim article the yield is manageable) Step 3: Evaluate the Evidence Not all evidence is of equal quality. Critically appraising studies ensures they are valid, reliable, and applicable. Evaluate: Validity Reliability Usefulness Nurses must be able to critique research articles to identify strengths and weaknesses of studies and their resulting evidence Appraisal answers question “is the comparison difference significant enough to change nursing practice?” Step 3: Evaluate the Evidence Are the results VALID and RELIABLE?? What are the results and why are they important? Will the results help me care for my patients? Step 3: Evaluate the Evidence VA L I D I T Y RELIABILITY What it means: Is it measuring what What it means: Is it consistent? If you it’s supposed to measure? repeat the test or study, will you get the Simple example: If you step on a same results? scale to check your weight, it should Simple example: If you weigh yourself measure your weight—not your height multiple times on the same day, the scale or temperature. should give you the same weight each time Why it matters: A test or study must (assuming no changes). be valid to ensure its results are Why it matters: A test or study must be meaningful and accurate for the reliable to ensure its results are dependable purpose. and repeatable. Key Difference: Validity is about ___________________ Reliability is about ____________________ A good test or study should be both valid and reliable! Step 4: Apply the Evidence After identifying high-quality evidence, integrate it with: Clinical expertise: Use professional judgment and experience. Patient preferences: Discuss options with the patient, considering their values, circumstances, and goals. This collaborative approach ensures personalized care Nurses then expand the “EBP loop” by sharing findings with colleagues- dissemination! Step 4: Apply the Evidence Translate findings into practice by: Developing action plans Educating stakeholders Adapting to the setting Share results with others to promote learning and improvement. Options include: Presentations Publications Policy updates Barriers to Evidence-Based Practice Resistance to change from traditional patient care routines Lack of time and funding Patient preferences that might conflict Limited knowledge of skills for finding and evaluating evidence Lack of experience, confidence in developing strategies to promote EBP Lack of support from supervisors or agency personnel