Chapter 2: Building An Evidence-Based Nursing Practice PDF

BUILDING AN EVIDENCE-BASED NURSING PRACTICE By: ELVIE A. IMASON-RAMOS, MAN, RN  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Learning Outcomes: At the end of the chapter, the learner should be able to: Define evidence-based practice List source of evidence for...

BUILDING AN EVIDENCE-BASED NURSING PRACTICE By: ELVIE A. IMASON-RAMOS, MAN, RN  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Learning Outcomes: At the end of the chapter, the learner should be able to: Define evidence-based practice List source of evidence for nursing practice eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Learning Outcomes: Identify barriers to the adoption of EBP and pinpoint strategies to overcome them. Explain how the process of diffusion facilitates moving evidence into nursing practice eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE “Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence.” - John Adams eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice Started in the field of medicine Dr. Archie Cochrane (1971) was concerned that evidence was not being critically examined. He stressed that random clinical trials are the “gold standard” for generating reliable and valid evidence. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice Evidence from clinical research should be used over intuition, unsystematic clinical experience, and pathophysiology (Cullum, et. al., 2008) An important approach to provide the best quality care to patients and their families. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice Maintained that practice based on evidence can help decrease uncertainty commonly experienced by both patients and health care professionals particularly nurses in today’s complex health care system (Mylnek & Finecout-Overholt, 2004) eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice Research has shown that patients who receive care based on evidence from well designed studies experience better outcomes and early recovery. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice Simply the integration of the best possible research evidence with clinical expertise and with patients needs (Porter-O’Grady, 2006) Three Factors Merge.doc eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice: Five (5) Key Steps 1. Formulation of a clinical question; 2. Gathering the best evidence to answer the clinical question; 3. Critical appraisal of the best evidence or research based information; 4. Integration of the evidence with the nurse own expertise, eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice: Five (5) Key Steps assessment of patients condition, available resources and patients’ preferences and values to implement a clinical decision; 5. Evaluation of the practice change, as a result of implementing the evidence. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE PICOT Format Introduced by Melynk & Finecout-Overholt (2004) advocate asking clinical questions in the PICOT Format: P – patient population I – intervention of interest C – comparison intervention O – outcome T – time target eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE P – Patient Population It is necessary to have a clear description of the patient population and setting retrieve the most relevant evidence; eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE I – Intervention of Interest This may include, but is not limited to any treatment, patient perception, exposure or diagnostic test. The more defined the intervention, the more focused the search for evidence will be; eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE C – Comparison Intervention The standard of care is compared to a new treatment or procedure. The comparison can be a true control such as placebo; eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE O - Outcome Specific identification of the outcome variable facilitates the search for evidence that has investigated the same outcome; eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE T – Time Target Specific time for the intervention to achieve the best outcome. The authors maintained that asking the questions in this format will yield the most relevant and best evidence. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice Remember: it is common for nurses to implement change fail to evaluate the effectiveness based on evidence but of that change. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice Evaluation of practice change is paramount in order to determine how a particular treatment worked or the effectiveness of clinical decision. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice Problem solving approach, EBP therefore incorporates research based information, nurse’s clinical expertise and research skills, patient’s reference, values and expectations within the context of caring to generate the best patient outcome. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice Combined the three nature of EBNP. ✓ Level I: Evidence obtained from at least one properly designed randomized controlled trials; eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice ✓Level II: Evidence obtained from well designed controlled trials without randomization, well designed case control analytic studies or multiple time series with or without intervention; and eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence-based Practice ✓ Opinions of respected authorities based on clinical experiences, descriptive studies or report of experts. ✓The elements of EBP 1. Nurse clinical experience and expertise 2. Client preferences 3. Research based information eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice The nurse clinical decision required for evidence-based health care. It is informed by factors such as valid, relevant research findings or best evidence, client preferences, sound judgment, skills and expertise of the nurse as well as the resources available to the nurse and the client. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice Is about providing care that is supported by research and clinical trials. Not all practice can be evidence based, nurses must used the best available information on which to base their interventions. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice To incorporate research findings into practice is essential in developing a science based practice. Evidence for research studies encourage nurse practitioners to adopt the practices that have been found useful and to abandon those usefulness has not been supported by evidence. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice Nurses should discriminate between those that studies have been characterized as: ✓ Beneficial forms of care ✓Care that are likely beneficial ✓Care with trade off between beneficial and adverse effects eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice ✓ Care with unknown effectiveness ✓Care that are unlikely beneficial, and ✓Care that are likely to be ineffective or harmful. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice To justify the worth of evidence: Systematic review of randomized controlled trials are conducted to determine biased or consistent findings. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice Latest protocol guideline issued by WHO through DOH issued A.O. 2009- 0025 Essential Newborn Care (ENC) under the umbrella of the “Unang Yakap” eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice Issued by DOH, mandating all hospital to implement the four (4) steps of newborn care time-bound intervention to lessen neonatal deaths. WHO-DOH.doc eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice As a result of systematic reviews, the best practice and better ways to achieve nursing goals in its operational, clinical and financial perspective can be improved. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice Nurses have now the resources with which to identify successful practices and use them as standards for safe practice. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice Similar to benchmarking which supports and promotes continual quality improvement and helps nurses remain steadfast and competitive in the health care market. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice Evidenced based research also uses collaborative benchmarking which involves sharing of strategies and outcomes. Evidence was arranged in a hierarchy according to level of credibility (Ferguson & Day, 2005) Pyramid of evidence.doc eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE The of Evidence-based Nursing Practice Each sources of evidence is necessary within the context on which type of evidence are suggested. The primary challenge for nurses is the establishment of criteria for assessing and determining acceptable evidence. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Characteristics Evidence-based Practice in Nursing EBP is a problem solving approach to nursing practice that involve the conscientious use of current best evidence in making decisions about patient care. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Characteristics Evidence-based Practice in Nursing It is also consider the nurse expertise and patients values and expectations. The nurse capacity to identify each patient’s unique health status and diagnosis, potential risks, and benefits of nursing interventions. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Characteristics Evidence-based Practice in Nursing It can come up with best available evidence by using research in combination with theory. Research and theory allows for accuracy of the nursing care plans, diagnostic tests, prognosis, and safety of therapeutic and preventive interventions. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Characteristics Evidence-based Practice in Nursing It allows client preferences and values to be heard. As nurses and clients interact, the preferences, concerns, and expectations of each client are all integrated into making clinical decisions. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice RU is the process of synthesizing, disseminating, and using research-generated knowledge into the nurse clinical practice. RU facilitates the transfer of innovation and purposive application of research findings to the current nursing practice (Polit & Beck, 2008) eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice RU is often used interchangeably with evidence-based practice since research utilization is but a part of evidence-based practice eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice DISSEMINATION – is a part of RU, is the process of knowledge transfer. It includes consideration of what, when, and how of moving ideas and information from the source(s). eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice e.g. researchers to intended recipient(s) such as client or patients. Research findings remain out of the reach for their intended users such as health workers and patients. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice Knowledge and interventions produced by nursing research remain untapped due to researchers’ limited resources and lack of identified utilization goals and targets. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice Purpose of research is to confirm current practice or to change it. The process of understanding and applying research findings into practice usually takes years, decades, or even generations. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice It is necessary to move carefully, new research output needs to evaluated, replicated and refined. The change process is evaluated, not by a rigorous review and refinement, but the gap between the research community and the standard of practice. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice e.g. it took some time, 264 years, from the discovery of citrus juice as preventive measure for scurvy and its use on British ship before it was widely accepted. (Glaser, Abelson, & Garrison, 1993, cited by Houser, 2008) eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice First Asia Pacific Conference in Nursing Research held in 2008 sought to address the issue and proposed measures to bridge the gap between research and its utilization in the Philippines. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Research Utilization (RU) & Evidence-based Practice Gathering and accounting for research outcomes and analyzing them for viability requires considerable financial resources. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Guide to Evidence-based Practice in Nursing Seven (7) models Stetler, Iowa and Roger’s Theory of Diffusion of Innovations has gained the general acceptance. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Guide to Evidence-based Practice in Nursing Common elements of these models which include: synthesis of evidence, implementation, evaluation of impact on patient care, and consideration of the context/setting in which evidence is implemented. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Guide to Evidence-based Practice in Nursing Stetler Model of Research Utilization (Stetler, 2001) Iowa Model of Research in Practice (Titler et. al., 2001) Roger’s Theory of Diffusion of innovations (1995) Ottawa Model of Research Use (Logan & Graham, 1998) eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Guide to Evidence-based Practice in Nursing Evidence-based Multidisciplinary Practice Model (Goode & Peidalue, 1999) Model for Change to Evidence- based Practice (Rosswurm & Larrabee, 1999) Center for Advanced Nursing Practice Model (Soukup, 2000) eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL Presents a structure for using the research outcomes and suggests a vehicle for changing policies and procedures. Nurse practitioner, educators, and policymakers, make a summary of research done and use it to influence educational programs, make practice decision, and policies. eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL Encompasses several steps: Preparation Validation Comparative Evaluation Decision Making Translation/Application Evaluation (Burns & Grove, 2007) eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL: Preparation Involves identifying the purpose and focus of the literature review Research literature may be reviewed to solve a difficult clinical, managerial, or educational problem eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL: Preparation To provide the basis for policy, standard or protocol To prepare for an in-service program or other type of professional presentation eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL: Validation A key consideration in validation is to determine whether the information is applicable and relevant to the current needs and problems of the nursing profession. eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL: Comparative Evaluation A review of findings of similar studies. The end result of the comparative evaluation is to make a decision about using the study findings for practical purposes eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL: Decision Making The researcher chooses from four possible options: To use; To consider use; To delay use; Reject the findings altogether If the decision is negative, no further steps are necessary eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL: Translation/Application The preparation for the actual implementation of the findings in the practice. The main question here is “how research knowledge should be applied?” keeping in mind always the beneficial effects to all consumers of health care. eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL: Evaluation Final stage which determines the impact of research findings on practice, policy, and patient care eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE STETLER MODEL: Evaluation Identifying validated research findings and utilizing the model, possible administrative policies could be designed to address the needs and problems of the nurse practitioner. eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE IOWA MODEL Provides direction for the development of evidence- based practice in clinical agency Initially developed by Titler and colleagues in 1994, revised in 2001. eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE IOWA MODEL The health agency, there are triggers that initiate the need for change, which is best made based on research evidence. eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE IOWA MODEL: Knowledge-focused triggers The pressure to change can be generated by a heightened awareness of new research findings derived from journal readings, participation in scientific conferences, and exposure to EBP guidelines eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE IOWA MODEL: Knowledge-focused triggers e.g. pain management, prevention of skin breakdown, assessing placement NGT or nasogastro-intestinal tube eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE IOWA MODEL: Problem-focused triggers It has its roots in a clinical or organizational problem. Discovery of these problems are usually by-products of quality improvement activities, risk surveillance, data benchmarking, review of financial performance among others. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE IOWA MODEL: Three Critical Decision Points 1. The problem is a sufficient priority for the organization exploring possible changes; 2. There is a sufficient research base; and 3. The change is appropriate for adoption in practice eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Roger’s Theory of Diffusion Model Is a theory of How, Why, and At What rate new ideas and technology spread through cultures Concept was first studied by (French) Gabriel Tarde and by (German) Friedrich Ratzel or Leo Frobenius (1890) eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Roger’s Theory of Diffusion Model Everette Rogers (1995) first discussed this theory in his textbook Rogers’ defines diffusion as “the process by which an innovation is communicated through certain channels over time among members of a social system” eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Roger’s Theory of Diffusion Model Diffusion of Innovations theory by Rogers includes five stage process: 1. Knowledge Stage 2. Persuasion Stage 3. Decision Stage 4. Implementation Stage 5. Confirmation Stage K-P DIC Process eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Roger’s Theory of Diffusion Model: Knowledge Stage These consists of the initial awareness of the existence of an innovation or a new idea for use in practice eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Roger’s Theory of Diffusion Model: Persuasion Stage The nurse develop an attitude toward the innovation eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Roger’s Theory of Diffusion Model: Decision Stage A choice is made to adopt or reject the innovation eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Roger’s Theory of Diffusion Model: Implementation Stage This involves using the new idea to change the current practice. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Roger’s Theory of Diffusion Model: Confirmation Stage Nurses seeks reinforcement of their decision leading to either a continuance of the adoption of the evidence or its rejection. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Roger’s Theory of Diffusion Model Rogers’ model could serve as useful guide during the early stages of research and can provide direction in implementing research-based intervention in nursing practice. eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Ottawa Model of Research The use of strategies to apply innovations into practice such as the use of evidence and other research findings to practice environment (Logan & Geraham, 1999) There six components of this model. eaimason74  Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Ottawa Model of Research 1. Practice environment 2. Potential research use 3. Evidenced based innovations 4. Strategies to apply innovations 5. Use of evidence 6. Health and other outcomes eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence Based Model Similar to Roger’s theory of diffusion of innovation Involves comprehensive information on certain issues and weighing pieces of evidence in relation to literature reviewed as basis to draw conclusion eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Evidence Based Model Nurses to get the best from research findings, they must take into account much of the evidences possible, organized and synthesized in a rigorous manner geared towards making accurate decisions for safe and effective patient care. eaimason74 Chap 2: BUILDING AN EVIDENCE-BASED NURSING PRACTICE Do yo u have quest ions? eaimason74