Week 5 BB2024 Evidence-Informed Practice PDF

Evidence informed practice/research October 8, 2024 How do you make important decisions? Gut feelings? Opinions of people you trust? Internet? Books? What should nurses rely on for decision making?   Explain the need for evidence to inform nurses' decision ma...

Evidence informed practice/research October 8, 2024 How do you make important decisions? Gut feelings? Opinions of people you trust? Internet? Books? What should nurses rely on for decision making?   Explain the need for evidence to inform nurses' decision making.  Identify the steps of evidence-informed decision making.  Discuss methods for developing new nursing knowledge. Ends in  Explain how nursing research improves view nursing practice.  To identify the different methodological approaches to developing new nursing knowledge  Understand the process of reading evidence-informed journal articles Nursing Research “'Google' is not a synonym for 'research'.” ― Dan Brown, What is research? Primary means by which new knowledge is discovered brought into practice to improve care that nurses provide to their patients A systematic examination of phenomena important to the nursing discipline  Can validate what we already know  Can refine existing knowledge  Can discover new knowledge  Improves nursing practice – raising standards (Potter & Perry, 2024, Kozier et al. 2018)) Importance of Nursing Research  It empowers every nurse’s clinical practice  Helps with decision making  Nurses can ask questions aimed at gaining new knowledge to improve patient care, the nursing profession and health care overall History of Nursing Research Began formally with Nightingale and the Crimean War in the mid 1800s Detailed nursing actions and outcomes Early 1900’s – established university nursing programs 1969 - practice oriented research – first nursing research journals in Canada – Nursing Papers now known as the Canadian Journal of Nursing Research 1971 – first national nursing research conference 1970’s& 1980’s – established research training in doctoral programs and funding to support nursing research 1990’s – Canadian government establishes nursing research fund Research process Research questions PICOT Format for Stating Clinical Questions P- what is the age gender, P – patient, problem, population ethnicity, disease or health of interest problem I – intervention of interest I- what is the best intervention(treatment, C – comparison of interest diagnostic test) O – outcome C- what is the current T – time frame in which change intervention, standard of will occur care O- what result do you want to achieve as a result of the intervention Clinical questions PS format for qualitative questions Looking at context or experiences P – population- who are the people involved S- situation- what circumstances or experiences do you want to know about Research design  Overall plan for answering the research question  Different designs depending on the research  Research approach will help determine the research design  Qualitative vs Quantitative approaches Quantitati Qualitati ve ve Studies concepts, Studies phenomena, concepts constructs, variables Information gathered by data Information gathered by (narrative) data (numerical) Links in concepts- patterns Links in concepts- Reasoning – inductive relationships Quality of evidence- Reasoning – deductive trustworthiness Quality of evidence – Find meaning of social or reliability, validity, human issue within a particular generalizability context Quantify and describe, Can not be measured or compare, or predict various quantified aspects  Deductiv Inductiv e e  Process of  Process of reasoning from developing specific specific observations to predications from more general rules general principles  A=B, B=C so A=C  Interview patients with cancer on their ability to  Jelonet is the best cope. burn dressing  My patient has a  From the information in the burn interviews, develop a model  I should use jelonet around how people cope with cancer for my patient https://danielmiessler.com/blog/the-difference-between-deductive-and-inductiv Qualitative Poses questions about nursing phenomena, not measured or quantified Understand the perspective of the subjects Transferability – extent that which the findings of the study are thought to be meaningful and applicable to other situations Qualitative designs Phenomenological  Philosophy and psychology  Meaning of peoples experiences concerning some phenomenon ‘lived experiences’  Based on philosophy that accepts an individuals perception of an experience is what matters (lived experiences)  “only people who experience the phenomena are capable of communicating these experiences” (Husserl, 1931-1962)  In depth conversations  Example – study describing seniors’ perceptions of their relationships with home care health providers Grounded theory  Sociology based  Account for patterns or behaviours relevant to study participants  Uses constant comparison of new data to develop theory  Core categories or concepts emerge  New perspectives on old problems  Theories or propositions grounded in real world observations  Example – study done to develop a caring theory from the perspective of nurses from urban hospitals Ethnography  Anthropology  Understand the world view of participants  Lengthy observational fieldwork observing participants within a cultural setting of interest (i.e. behavior in a social setting)  Looking at participants meanings of actions or events  Field notes  Example – study racialization within the context of health care service use among indigenous people Qualitative or Quantitative  Participatory action research  Idea that knowledge can be political and used to exert power  Used working with vulnerable groups  Collaboration between researcher and participants to define problem, select approach, and how to use findings  Case study  Involves thorough, in-depth analysis of an individual, group, institution, or other social unit  Historical research  Systematic studies used to discover facts and relationships about past events  Quantitative designs Experimental – questions at level III - why Randomized controlled trials or RCT 1. Random assignment to a group, Control group for comparison 2. Manipulation of a special treatment 3. Researcher proposed theory based and statistically tested hypothesis about the action of the variable. Quasi experimental  Lacks one of the three above characteristics Quantitative designs Descriptive designs - Surveys-–what is the relationship  Information from group or population on a topic of interest  Does the survey yield informative or uninformative results  Relationships between variables  May have sampling errors if sample size not big enough  Measurement tools must yield accurate measurements  Quantitative designs Exploratory descriptive designs – level 1 – what?  Describes populations or variables not previously studied  Provides detailed description , does not describe a relationship  No active intervention by researcher Data analysis – all quantitative designs use statistical analysis Research synthesis Systematic strategies to review appraise and synthesis findings from the literature on a specific topic = systematic reviews All include asking a question, searching the literature, screening the literature, reading then appraising the literature for quality Often conducted with a team Generate new knowledge through synthesizing findings across diverse research studies https:// jbi.global/ Ackerman, Jeffs, Simpson, & Williams (2021) Discussing innovation from three different projects Research or evidence based practice?  Reading Research papers Important to recognize the importance of each part of the research paper https://www.youtube.com/watch?v=2sgs77U1Kus Parts of a research paper Abstract Introduction Literature review Method Results/Findings Discussion Evidence informed practice Themes of professionalism included a body of knowledge and specialized education RNAO professionalism BPG – Knowledge…Using theory or evidence based rationale for practice Background CNO entry to practice document (2020) The entry-level registered nurse: 1.23 Uses knowledge of the impact of evidence informed registered nursing practice on client health outcomes 1.27 Implements evidence-informed practices for infection prevention and control. 3.3 Uses evidence-informed communication skills to build trusting, compassionate, and therapeutic relationships with clients 9.1 Uses best evidence to make informed decisions 9.7 Supports research activities and develops own research skills Evidence based practice “Evidence-based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.” Sacket et al. as cited in Woodbury and Kuhnke, 2014 Example of EBP – RNAO BPG’s Focused on developing, disseminating, implementing, sustaining, monitoring and evaluating clinical and healthy work environment (HWE) BPGs. The guidelines translate research evidence into recommendations for point-of-care practice, health professional education and organizational policy. They enhance work environments, improve the quality and consistency of care, increase access to quality services, reduce health-care costs, and maximize provider, patient, organizational and health system outcomes. 50 BPG’s published https://rnao.ca/sites/rnao-ca/files/vision-docs/RNAO-Vision-Nurturing-Evidenced-Based-Practice-and-H What did you find in BPG’s Person and Family centered care How developed? How can it be incorporated into nursing practice?  CNA 2018 document -the ongoing process that incorporates evidence from research findings, clinical expertise, client preferences and other available resources to inform decisions that nurses make about clients (Ciliska, Pinelli, What is… DeCenso & Cullum, 2001; Scott, McSherry, 2008). Evidence- informed Textbook -refers to CNA (2018) decision making Woodbury & Khunke (2014) – “provide more flexibility regarding the nature of the evidence and its use; i.e., it implies that many different levels of evidence and types of evidence (described above) are needed and used to support decisions in clinical practice”. Evidence-Informed Clinical Decision Making  Need to obtain information from multiple sources  Evidence from research, evidence-informed theories, clinical experts and leaders  Clinical expertise  Patient preferences and values  Evidence from patient assessment, history, and available health care resources Evidence based process Asking a well developed answerable question Search for and collect the most relevant best evidence Critically appraise the evidence (consider validity, truth, size of effect, and applicability to practice) Integrating the critical evaluation with clinical expertise and the patients unique circumstance and values Evaluating the outcome of the practice decision or change and modify as necessary Disseminate the outcomes of the decision or change Box 8.1 Asking the question PICO(T) or PS Collect the best evidence Search databases – contain published empirical studies – peer review Levels of evidence – quantitative  Sources of research evidence Systems Sophisticated electronic system that link to patient records and prompt practitioners about guidelines for care Summaries Summaries of synthesized sources of research evidence for a given health issue Synopsis of syntheses Summaries of the findings from systematic reviews Syntheses Synthesis of primary studies by using systematic review methods to answer a focused research question Synopsis of single studies A summary of the results and implications of single studies Studies Single research studies related to a particular focused question Critique the evidence Research literacy – essential competency for evidence informed practice – ability to locate understand and critically evaluate empirical literature for application to practice Look for scientific merit Clinical applicability Determine if findings strong enough to implement into practice Integrate the evidence Apply research into plan of care May try a pilot study Evaluate the change Do you need a formal evaluation ? How long will you evaluate the practice change for? Evidence-Informed Practice  It is a continuous process selecting the best available evidence to provide care  It is essential to optimize outcomes for patients, communities, and populations EBP Woodbury & Khunke Duggleby and Astley vs EIP 1. Asking a well developed 1. Ask a question that clearly answerable question states clinical problem 2. Searching for evidence 2. Identify and gather the most 3. Evaluating appraising the relevant and best evidence evidence for validity, truth, 3. Critically appraise the size of effect and applicability evidence to practice 4. Integrate all evidence with 4. Integrating the critical clinical expertise, patients’ evaluation with clinical preferences, and patients’ expertise and the patients values to make a practice unique circumstance and decision or change values 5. Evaluating the effectiveness 5. Evaluate the outcome of the for next time practice decision or change How do they differ? “Evidence informed decision making is broader not only in use of evidence but also incorporating patients values, beliefs, choices, and cultural and/or religious practices as well as ethics, legislation, policy, health care resources and the resources and context of the practice settings all of which influence decision making” May include documents, commissioned reports, expert panels, policy and practice standards, regulation, and historical or experiential information (CNA, 2010)  Evidence- Research Quality Informed Improvement Decision Making Purpose Use of Systematic Improves local information from inquiry answers work processes to research and questions, improve patient experts to solves problems outcomes; results improve patient and adds to usually not care outcomes knowledge base generalizable of nursing Focus Implementation Evidence is Measures effects of of evidence generated to practice on specific find answers population Data sources Research Subjects or Patients or patient studies, experts, participants in records from the patients, the study specific area experience Who conducts Practicing nurses Researchers Employees of the activity? health care agency – nurses, physicians, pharmacists Peer reviewed articles  What are they... How do you know?  How do you ensure you have peer-reviewed articles when you search the library? In summary  Evidence informed practice  Evidence informed decision making  Research is an important facet in nursing. Why? Reading evidence informed journal articles Next week October 14 – study week October 19 – dynamics in the profession, group project introduction