EBP Toolkit PDF

Evidence-Based Nursing Practice Toolkit Adapted from The Johns Hopkins Nursing Evidence-Based Practice Model (2003) for KFSH&RC- Jeddah by: Gillian Sedgewick MSc, BSc (hon), DPSM, RN, RM KFSH&RC-Jeddah Evidence-Bas...

Evidence-Based Nursing Practice Toolkit Adapted from The Johns Hopkins Nursing Evidence-Based Practice Model (2003) for KFSH&RC- Jeddah by: Gillian Sedgewick MSc, BSc (hon), DPSM, RN, RM KFSH&RC-Jeddah Evidence-Based Practice Model Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16 Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16  ACKNOWLEDEGEMENTS Practice Question Tool Development 1. What is the problem and why is it important? Date: 01 Oct 2020 Requestor name: 2. What is the current practice? Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16 3. What is the focus of the problem? Clinical ⃝ Educational ⃝ Organizational/ System ⃝ 4. How was the problem identified? ⃝ Safety/risk management ⃝ Quality concerns (efficiency, effectiveness, timeliness, equity ⃝ Unsatisfactory patient, ⃝ Variations in practice staff or organizational outcome ⃝ Evidence validation for current practice ⃝ Financial concerns ⃝ Clinical practice concern ⃝Adverse event 5. What is the scope of the problem? Individual ⃝ Population ⃝ Organizational/system ⃝ 6. What are the PICO components? P=Population I= Intervention C=Comparison O= Outcome Search terms to be used in databases: Population (P) Intervention (I) Comparison (C) Outcome (O) Other meaning for words identified in (P) (I) (C) (O) to support further search topics to gain relevant evidence Other meanings for P Other meanings for I Other meanings for C Other meanings for O 7. Initial EBP question: 8. List databases searched and search strategies: 9. Other sources of evidence gathered (Internal and external)? ⃝ Standards (Regulatory, Professional) ⃝ Guidelines ⃝ Expert opinion ⃝ Patient family preferences Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16 ⃝ Clinical expertise ⃝Quality /Outcome data 10. Literature reviewed using RESEACH and NON RESEARCH evidence Appraisal tools : 10.1. RESEARCH-Evidence Appraisal Tool Analyze phase Evidence Rating: Article Title: Authors: Date Journal: Setting: Sample size ⃝Experimental ⃝Meta- ⃝Quasi- ⃝Non- ⃝Qualitative ⃝Meta- analysis experimental experimental synthesis Does this study apply to the population targeted by my practice ⃝ YES ⃝NO question? If the answer is NO. STOP here ( unless there are similar characteristics) Strength of Study Design Was the sample size adequate and appropriate? ⃝YES ⃝NO Were study participants randomized? ⃝YES ⃝NO Was there an intervention? ⃝YES ⃝NO Was there a control group? ⃝YES ⃝NO If there was more than one group, were groups equally ⃝YES ⃝NO treated, except for the intervention? Was there adequate description of the data collection ⃝YES ⃝NO methods? Study Results Were results clearly presented? ⃝YES ⃝NO Was an interpretation/analysis provided? ⃝YES ⃝NO Study Conclusion Were conclusion based on clearly presented results? ⃝YES ⃝NO Were study limitations identified and discussed? ⃝YES ⃝NO Pertinent Study Findings and Recommendations: Will the results answer the practice question? ⃝YES ⃝NO Evidence Rating Strength of ⃝Level I ⃝ Level II ⃝ Level III ⃝ Level IV ⃝ Level V Evidence (Strong) Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16  Quality of Evidence (check one) ⃝ High (A) ⃝Good (B) ⃝ Low/Major 10.2. RESEARCH Evidence Appraisal Tool Rating Table Analyze Phase Strength of Evidence Level 1 (Strong) Experimental Study (Randomized controlled Trials or RCT) ▪ Study participants (subjects) are randomly assigned to either a treatment (Tx) or control (non- treatment) group: ▪ May by: Blind: subject does not know which Tx subject is receiving. Double- blind: neither subject nor investigator knows which Tx subject is receiving Non-blind: both subject and investigator knows which Tx subject is receiving; used when it is felt that the knowledge of treatment is unimportant. Meta- Analysis of RCTs Quantitatively synthesizes and analyzes results of multiple primary studies addressing a similar research question. Statistically pools results from independent but combinable studies. Summary statistic (effect size) is expressed in terms of direction (positive, negative, or zero) and magnitude (high, medium, small) Level II Quasi- Experimental Study Always includes manipulation of an independent variable Lacks either random assignment or control group Findings must be considered in light of threat to validity (particular section) Level III Non-Experimental Study No manipulation of the independent variable Can be descriptive, comparative, or relational Often uses secondary data Findings must be considered in light of threats to validity (Particularly section, lack of severity or co-morbidity adjustment) Qualitative Study Exploratory in nature, such as interviews, observations, or focus groups. Starting point for studies questions for which little research currently exists Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16  Sample sizes are usually small and study results are used to design stronger studies that are more objective and quantifiable. Meta-Synthesis Research technique that critically analyzes and synthesizes finding from qualitative research Identifies key concepts and metaphors and determines relationships to each other Aim is not to produce a summary statistic, but rather to interpret and translate findings RESEACH Evidence: Quality of Evidence (Scientific Evidence) A. High: consistent results, sufficient sample size, adequate control, and definitive conclusions; consistent recommendations based on extensive literature review that includes thoughtful reference to scientific evidence B. Good: reasonably consistent results, sufficient sample controls, and fairly definitive conclusions; reasonably consistent recommendations based on fairly comprehensive literature review that includes some reference to scientific evidence C. Low/Major flaw: little evidence with inconsistent results, insufficient sample size, conclusions cannot be drawn. 10.3. NON-RESEARCH Evidence Appraisal Tool Analyze phase Evidence Rating: Article Title: Authors: Date Journal: ⃝Systematic ⃝Clinical ⃝Organizational (PI project, ⃝ Expert opinion, case Review Practice NDNQI, etc) study, literature review Guidelines Does this study apply to the population targeted by my practice ⃝ YES ⃝NO question? If the answer is NO. STOP here ( unless there are similar characteristics) Systematic Review Is the questions clear? ⃝YES ⃝NO Was a rigorous peer-review process used? ⃝YES ⃝NO Are search strategies specified and reproducible? ⃝YES ⃝NO Are search strategies appropriate to include all pertinent ⃝YES ⃝NO studies? Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16  Are criteria for inclusion and exclusion of studies specified? ⃝YES ⃝NO Are details of included studies (design, methods, and ⃝YES ⃝NO analysis) presented? Are methodological limitations disclosed? ⃝YES ⃝NO Are the variables in the studies reviewed similar so that ⃝YES ⃝NO studies can be combined? Clinical Practice Guidelines Were appropriate stakeholders involved in the development ⃝YES ⃝NO of this guideline? Are groups to which guidelines apply and do apply clearly ⃝YES ⃝NO stated? Have potential biases been eliminated? ⃝YES ⃝NO Were guidelines valid (reproducible search, expert ⃝YES ⃝NO consensus, independent review, current and level of supporting evidence identified for each recommendation)? Are recommendations clear? ⃝YES ⃝NO Organizational Experience Was the aim of the project clearly stated? ⃝YES ⃝NO Is the setting similar to setting of interest? ⃝YES ⃝NO Was the methodology adequately described? ⃝YES ⃝NO Were measures identified? ⃝YES ⃝NO Were results adequately described? ⃝YES ⃝NO Was interpretation clear and appropriate? ⃝YES ⃝NO Individual expert opinion, case study, literature review Was evidence based in the opinion of an individual? ⃝YES ⃝NO Is the individual an expert in the topic? ⃝YES ⃝NO Is author’s opinion based on scientific evidence? ⃝YES ⃝NO Is the author’s opinion clearly stated? ⃝YES ⃝NO Are potential biases acknowledged? ⃝YES ⃝NO Pertinent Study Findings and Recommendations: Will the results answer the practice question? ⃝YES ⃝NO Evidence Rating Strength of ⃝Level I ⃝ Level II ⃝ Level III ⃝ Level IV ⃝ Level V Evidence (Strong) Quality of Evidence (check one) ⃝ High (A) ⃝Good (B) ⃝Low/Major Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16 10.2. Non-Research Evidence Appraisal Tool Rating Table Analyze Phase Strength of Evidence Level IV Systematic Review Research review that compiles and summaries evidence from research studies related to specific clinical question Employs comprehensive research strategic and rigorous appraisal methods Contains an evaluation of strength and limitations of studies under review If peer-reviewed process such as Cochrane is used, rate at the level of the research evidence included in the review if not a meta- analysis which is rated at level i. if non-peer reviewed, rte at Level IV Level IV Clinical Practice Guidelines Research and experimental evidence review that systematically develops statements that are meant to guide decision-making for specific circumstances Evidence is appraised and synthesized from three basic sources: scientific findings, clinician expertise, and patients’ preferences. LeveI V (Weak) Organizational Review of quality improvement studies and financial analysis reports Evidence is appraised and synthesized from other basic sources: internal reports and external published reports. Expert Opinion, Case Study, Literature Review Opinion of a nationally recognized expert based on non-research evidence (includes cases studies, literature review, or personal experience) Quality of Evidence (Summary Review) A. High: well defined, reproducible research strategies; consistent results with sufficient numbers of well-designed studies; criteria- based evaluation of overall scientific strength and limitations of included studies, with fairly definitive results. B. Good: reasonably thorough and appropriate search; reasonably consistent results, sufficient number of well-designed studies; evaluation of strength and limitation of included studies; with fairly definitive results C. Low/Major flaw: undefined, poorly defined, or limited search strategies; insufficient evidence with inconsistent results, conclusion cannot be drawn Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16  Quality of Evidence (Expert Opinion) A. High: expertise is clearly evident B. Good: expertise appears credible C. Low/Major flaws; expertise is not discernable or is dubious Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16  11.1. Evidence Summary Articl Publication Level of Title of article Purpose Method/ Design Summary e no Date Evidence 1 2 3 Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16  4 5 6. 7 Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16 11.2. Reference list with full citations of articles reviewed for this EBP question Adopted from: The Johns Hopkins Nursing Evidence- Based Practice Model 2003. KFSH&RC-Jeddah 18.12.16