UNIT 5 EVIDENCE BASED PRACTICE.pptx

UNIT 5 :EVIDENCE - BASED PRACTICE AND RESEARCH IN NURSING BY MADAM SALIDA LEARNING OUTCOMES At the end of this session , the students should be able to : 1. Define Evidence –Based Practice 2. State the components of Evidence –Based Practice 3. State the steps involves in...

UNIT 5 :EVIDENCE - BASED PRACTICE AND RESEARCH IN NURSING BY MADAM SALIDA LEARNING OUTCOMES At the end of this session , the students should be able to : 1. Define Evidence –Based Practice 2. State the components of Evidence –Based Practice 3. State the steps involves in Evidence Based Practice(EBP). 4. Explain the need of Evidence Based Practice. LEARNING OUTCOMES 5.State the model involves in of Evidence Based Practice. 6. Explain 5 steps involves in Evidence Based Practice. 7. Explain advantages of Evidence Based Practice. EVIDENCE BASED PRACTICE (EBP) Introduction Evidence-based practice (EBP) is the conscientious and judicious use of current best evidence in conjunction with clinical expertise and patient values to guide health care decisions WHAT IS EVIDENCE- BASED PRACTICE IN NURSING Evidence-based practice is a conscientious, problem-solving approach to clinical practice that incorporates the best evidence from well- designed studies, patient values and preferences, and a clinician's expertise in making decisions about a patient's care. Unfortunately, no standard formula exists for how much these factors should be weighed in the clinical decision-making process. CON’T However, there are a variety of rating systems and hierarchies of evidence that grade the strength or quality of evidence generated from a research study or report. Being knowledgeable about evidence-based practice and levels of evidence is important to every clinician as clinicians need to be confident about how much emphasis they should place on a study, report, practice alert or clinical practice guideline when making decisions about a patient's care. PRACTICAL EBP PRACTICED ASED ON NURSING PROCES MODEL FOR EVIDENCE BASED CLINICAL DECISION MAKING EVIDENCE FROM RESEARCH ,EVIDENSE BASED THEORIES ,CLINICAL EXPERTS AND OPINION LEADERS EVIDENCE FROM EVIDENCE ASSESSMENT BASED OF PATIENTS’S CLINICAL CLINICAL HISTORY AND EXPERTISE DECISION PHYSICAL AND MAKING AVAILABLE HEALTHCARE RESOURCES INFORMATION ABOUT PATIENT PREFERENCES AND VALUES STEPS OF EVIDENCE -BASED PRACTICE(EBP) EBP is a systematic , problem solving process that facilitates achievement of best practices. Consistently following a step by step approach ensures that you obtain the strongest available evidence to apply in patient care Con’t There are 7 steps of EBP , which are number from 0 to 6 ( Melynk and Fineout –Overholt ,2014) 0.Cultivate a spirit of inquiry 1. Ask a clinical question in PICOT format 2. Search for the most relevant and best evidence 3. Critically appraise the evidence you gather 4. Integrate all evidence with your clinical expertise and patient preference and values 5. Evaluate the outcomes of practice decision or changes using evidence 6. Share the outcomes of EBP changes with others Developing a PICOT Question P = Patient popular of interest Identify patients by age, gender ,ethnicity ,and disease or health problem I = Intervention of interest Which Intervention is worthwhile to use in practice (eg: treatment ,diagnostic test , prognosis factor )? C = Comparison of interest What is the usual standard of care or current intervention used now in practice ? Developing a PICOT Question O =Outcome What result do you wish to achieve or observing as a result of an intervention (eg: change in patient behaviour ,physical finding , or patient perception ? T = Time What amount of time is needed for an intervention to achieve an outcome ( eg: the amount of time needed to change quality of life or patient behaviour ? Searchable Scientific Literature Databases and Sources Databases Sources AHRQ Agency for Healthcare Research and Quality ;includes clinical guidelines and evidence summaries http://www.ahrq.gov CINAHL Cumulative Index of Nursing and Allied Health Literature ; includes studies in nursing ,allied health, biomedicine http:// www.cinahl.com Searchable Scientific Literature Databases and Sources MEDLINE Includes studies in medicine,nursing ,dentistry ,ps ychiatry ,veterinary medicine and allied health http:// www.ccbi.nim.nih.gov EMBASE Biomedical and pharmaceutical studies http://www.embrace.com Psyc/NFO Psychology and related health care disciplines http://www.apa.org/psycinfo/ Searchable Scientific Literature Databases and Sources Cochrane Database of Full text of regularly updated systematic Systematic Review reviews prepared by Cochrane Collaboration ;includes completed reviews and protocols http://www.Cochrane.org/reviews National Guidelines Repository for structured abstracts Clearinghouse (summarizes ) about clinical guidelines and their development ;also includes condensed version of guideline for viewing Http:www.guideline.gov PubMed Health science library at the National Library of Medicine ;offers free access to journal articles http://www.nlm.nih.gov Worlds Views on Evidence Electronic journal containing articles that –Based provide a synthesis of research and Nursing annotated bibliography for selected references Example of EBP Through evidence-based practice, nurses have improved the care they deliver to patients. Key examples of evidence-based practice in nursing include: Giving oxygen to patients with COPD: Drawing on evidence to understand how to properly give oxygen to patients with chronic obstructive pulmonary disease (COPD). EXAMPLE OF EBP  NURSING RESEARCH Nursing research Nursing research improves the health and welfare of people Nursing research is a way to identify new knowledge ,improve professional; education and practice and use nursing and health care resources effectively Research means : to search again or to examine carefully It is a systematic process provides a scientific basis for generate knowledge Con’t The knowledge provides a scientific basis for nursing practice and validates the effectiveness of nursing interventions The scientific knowledge base of nursing continues to grow today Thus furnishing evidence that nurses can use to provide safe and effective patient care Many professional and specially nursing organizations support the conduct of research for advancing nursing science  Outcomes research Outcomes research helps patients , healthcare providers and those in health care policy make informed decisions on the basis of current evidence ( PCORI , 2015) Outcomes research typically focuses on the benefits ,risks ,costs and holistic effects of the treatment of patient.  The outcome research is patient satisfaction ,observed through patients’ responses to a patient satisfaction instrument ,including characteristics such as nursing care, physician care, support services and environment Scientific method Scientific method is the foundation of research and the most reliable and objective of all methods of gaining knowledge This method is an advanced ,objective means of acquiring and testing knowledge Aspect of the method guide you in applying evidence gained from research in practice and conducting future research Nursing and Scientific Approach Quantitative research Quantitative nursing research is the study of nursing phenomena that offers precise measurement and quantification Quantitative research is the precise ,systematic ,objective examination of specific concepts It focuses on numerical data ,statistical analysis and control to eliminate bias in finding (Polit and Beck ,2011) Con’t Qualitative research Is the study of phenomena that are difficulty to quantify or categories such as patients’ perception of illness or quality of life This research method describes information obtained in nonnumeric form ( eg: data in the form of transcribed written transcript from a series of interviews ) Con’t Qualitative researchers aims to understand patients’ experiences health problems and the context in which the experiences patients had Patients have opportunity to tell their stories and share the experiences in this studies The findings are in depth and very descriptive CONCLUSIO N ‘...Evidence based practice is not simply a pragmatic, logical process, involving access to, and the subsequent use of best research evidence. There is an interplay of multiple factors that influence decisions about patient care; an evidence, context, expert practice/experience and patients’ preferences and wishes…’ (Closs & Cheater, 1999)