Lecture2 Evidence-Based Nursing Practice.pdf

Introduction to Nursing Research EVIDENCE-BASED NURSING PRACTICE PROF. REHAM KHRESHEH  Objectives On completion of this chapter, you will be prepared to: 1. Summarize the importance of evidence-based practice in the field of nursing. 2. Differentiate between research utilization a...

Introduction to Nursing Research EVIDENCE-BASED NURSING PRACTICE PROF. REHAM KHRESHEH  Objectives On completion of this chapter, you will be prepared to: 1. Summarize the importance of evidence-based practice in the field of nursing. 2. Differentiate between research utilization and evidence-based nursing practice. 3. Discuss the importance of the Cochrane Collaboration and the Cochrane Nursing Care Field to evidence-based practice. 4. Summarize the roles of evidence-based nursing practice centers 5. Describe models that promote the implementation of EBP in nursing practice 6. Identify barriers that could challenge the effective implementation of an EBP PROF. REHAM KHRESHEH Defining Evidence-Based Practice The term evidence-based practice (EBP) originated in the field of medicine. Most people credit the beginning of the movement toward EBP to Archie Cochrane, a British medical researcher and epidemiologist. His work pointed out the lack of solid evidence about the effects of healthcare. Sackett et al. (1996) initially defined evidence based medicine as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”. Later, clinical expertise and patient values were included as determinants for EBP clinical decision making. Sigma Theta Tau International, the Honor Society for Nursing defined EBP as “an integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served”. PROF. REHAM KHRESHEH Research Utilization versus Evidence-Based Practice Research utilization (RU): Is a more narrow term than evidence-based nursing practice. It involves the use of results from specific research studies that focused on one clinical problem and had good results. The knowledge from RU accumulates over time and works its way into practice. For example, we no longer routinely irrigate urinary drainage systems or clamp and disconnect the tubing when the patient ambulates. This research-driven recommendation is now widely accepted for clinical practice because research showed that interrupting the closed system increased the likelihood of a urinary tract infection (Harris,2010). PROF. REHAM KHRESHEH Research Utilization versus Evidence-Based Practice… Evidence-based practice : is broader in scope than RU because the clinician is expected to consider more than evidence during the clinical decision-making process (Ciliska et al., 2011).  expert clinicians are expected to consider the patient’s circumstances, as well as the results generated from outcomes management or quality improvement projects, the patient’s preferences and the available resources for clinical decision making (Ciliska et al., 2011). the creation of an EBP depends on a systematic approach that enables clinicians to identify best practices and determine if and how these practices can be introduced into the healthcare for a relevant patient population (Poe & White, 2010). PROF. REHAM KHRESHEH Evidence-Based Nursing Practice  The goal of EBP in nursing is to introduce current knowledge into common care decisions that will improve both the effectiveness of processes and the patient outcomes associated with healthcare In the presence of escalating healthcare costs EBP has also been promoted by public and professional desires for accountability in safety and quality improvement in healthcare services. As nurses have always wanted what is best for their patients/clients, it is appropriate that nurses incorporate EBPs into everyday nursing care practices. PROF. REHAM KHRESHEH Benefits of EBP The most celebrated benefits of EBPs are:  the improved patient outcomes that have been shown through the synthesis of many research studies  the use of EBPs relate to the way the Joint Commission (JC) and the American Nurses Credentialing Center (ANCC) have recognized them as the best treatment plans or standards of care for those who are maintaining accreditation and seeking Magnet Hospital recognition ( PROF. REHAM KHRESHEH Asking Clinical Questions The work of implementing an EBP begins with identifying a clinical problem that suggests there is a better way to provide care that will promote improved health in a cost-effective way. The acronym PICOT is a format for writing clinical questions that was developed by Fineout-Overholt and Johnston (2005). The five letters stand for: P = Patient or population , I = Intervention or interest area, C = Comparison intervention or current practice, O = Outcome(s) desired, T = Time to achieve outcome (optional) After the clinical question is created, a search of the relevant literature is used to assess the evidence that addresses the clinical issue and patient care question. PROF. REHAM KHRESHEH Sources for Evidence for Practice Research evidence can be classified as translational literature, evidence summaries, and primary evidence. Translational research refers to evidence that has been incorporated into guidelines that are used in clinical settings. Standards of practice, protocols, and critical pathways are examples of translational research, which can be found in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and the National Clearinghouse databases, or the Best Practice Information Sheets of the Joanna Briggs Institute. Evidence summaries such as systematic reviews are described as summaries of the literature that appraise research that is appropriate for the research question (Hain & Kear, 2015). Evidence summaries are typically found in nursing and non-nursing online databases, such as PubMed, CINAHL, the Cochrane Library, the Joanna Briggs Institute, and library catalogs. PROF. REHAM KHRESHEH Primary evidence may be collected directly from the patient or from clinical trial information, peer reviewed research articles in journals, conference proceedings, and large data sets from organizations(Hain & Kear, 2015). Databases from primary evidence may be found in PubMed, CINAHL, Excerpta Medical Medica Database (EM-BASE), and institutional sources. PROF. REHAM KHRESHEH The Cochrane Collaboration The Cochrane Collaboration:  Is an international nonprofit organization that supports efforts to make well-informed decisions about healthcare. The contributors of the Cochrane Collaboration are from more than 120 countries. It was established in 1993 and named after Archie Cochrane. There are 53 Cochrane Review Groups. Each group focuses on a specific topic area, such as breast cancer, drugs and alcohol, multiple sclerosis, and sexually transmitted diseases. These review groups provide authors with methodological and editorial support to prepare Cochrane Reviews. PROF. REHAM KHRESHEH The Cochrane Collaboration… Cochrane Reviews are based on the best available information about healthcare interventions. These reviews provide evidence for and against the effectiveness and appropriateness of treatments such as medications, surgery, and educational programs. A systematic review, also called an integrative review, is a rigorous scientific approach that combines results from a group of original research studies and looks at the studies as a whole. While focusing on a single area of interest, a systematic review may provide a summary of many studies at once. Interventions for Preventing Falls in Older People Living in the Community is an example of a systematic review that might be of interest to nurses (Gillespie et al., 2012). The results of this review identified which interventions helped to reduce falls among older people in the community. PROF. REHAM KHRESHEH The Cochrane Library The Cochrane Library is the medium used to publish the work of the Cochrane Collaboration. It consists of six databases that contain evidence to promote decision making in healthcare. These six databases are: (1) Cochrane Database of Systematic Reviews (CDSR), (2) Cochrane Central Register of Controlled Trials (CENTRAL),(3) Cochrane Methodology Register (CMAR), (4) Database of Abstracts of Reviews of Effects (DARE),(5) Health Technology Assessment Database (HTA), and (6) NHS Economic Evaluation Database (EED). A seventh database provides information about the groups in the Cochrane Collaboration. PROF. REHAM KHRESHEH Cochrane Database The main output of the Cochrane Collaboration, the Cochrane Reviews, is found in the Cochrane Database of Systematic Reviews, which is published electronically as part of the Cochrane Library archives. As new information is located, Cochrane Reviews are updated regularly and published online monthly, with quarterly DVDs. More than 6,300 reviews and 2,400 protocols were available in the Cochrane Database in May 2015. The protocols for Cochrane Reviews describe the research methods and objectives for reviews that are in progress. Abstracts of Cochrane Reviews are also available free online to everyone. These summaries are provided in easily understandable terms. PROF. REHAM KHRESHEH Cochrane Centers Cochrane Centers are located throughout the world, including locations in Australia, Brazil, Canada, China, Denmark, France, Germany, Italy, the Netherlands, South Africa, Spain, the United Kingdom, and the United States. All Cochrane Centers help to coordinate and support the members of the Cochrane Collaboration. Common responsibilities include helping people to find out about the Cochrane Collaboration and its reviews, providing training for people who will do reviews, fostering collaboration among people with similar research interests, and organizing workshops, seminars, and colloquia to support the Cochrane Collaboration.  Each center reflects the interests of the individuals associated with that particular center. PROF. REHAM KHRESHEH Cochrane Nursing Care Field The website for the Cochrane Nursing Care Field (CNCF) is one of twelve fields in the Cochrane Collaboration (CC). The purpose of the CNCF is to support the development of systematic reviews and the dissemination and utilization of systematic reviews that are relevant to the field of nursing. Some core functions include (a) identifying topics related to nursing care that are not covered in existing Cochrane reviews, (b) identifying primary studies in nursing care by searching databases, relevant journals, and conference proceedings, (c) promoting the field’s perspectives across the CC, PROF. REHAM KHRESHEH Cochrane Nursing Care Field… (d) raising awareness of the resources that the CC offers to nursing, (e) disseminating the findings of relevant Cochrane reviews to the nursing community, and (f) identifying sources of funding to undertake or complete Cochrane reviews of interest PROF. REHAM KHRESHEH Evidence-Based Nursing Practice Centers There are an increasing number of evidencebased practice centers in nursing. Three of these centers are: 1) the Academic Center for Evidence-Based Nursing, located at the University of Texas Health Science Center at San Antonio; 2) Joanna Briggs Institute, in Australia; and 3) Sarah Cole Hirsh Institute for Best Nursing Practices Based on Evidence, based at the Case Western Reserve University Frances Payne Bolton School of Nursing in Cleveland, Ohio. PROF. REHAM KHRESHEH Models to Promote Evidence-Based Practice in Nursing The Stetler Model This Model lists five phases of activities that guide the nurse through the process of implementing EBPs. They include: (1) preparation: includes the collection of information that provides the reason to change the practice as well as the strength of research evidence that will be used for the anticipated change (2) validation: includes a critical analysis of the research related to the potential practice. PROF. REHAM KHRESHEH Models to Promote Evidence- Based Practice in Nursing… (3) comparative evaluation and decision making: deals with the fit of the evidence to the clinical setting, the feasibility of using the research findings, and the decision that a new practice activity would make a positive difference to patient outcomes. (4) translation and application: involves the actual implementation of the practice. (5) evaluation : includes both informal and formal evaluations, which could be presented as case studies, audits, and quality assurance or outcomes research projects. PROF. REHAM KHRESHEH Models to Promote Evidence- Based Practice in Nursing… The Iowa Model  Suggests that the implementation of an EBP protocol rests on a continuum of activities that advance from (1) identifying either problem- focused or knowledge-focused triggers; (2) to forming a team; (3) to assembling, synthesizing, and critiquing the research associated with a practice that would provide a solution for the trigger; (4) to piloting the new practice; (5) to evaluating the structure, processes, and outcomes of the practice (with a potential possibility of modifying the practice before it is officially adopted); (6) to disseminating the results; and then (7) to returning to the first steps of identifying triggers that may indicate a need for a revision of the EBP. PROF. REHAM KHRESHEH Barriers Associated with EBP Although nursing research has generated evidence, there are many barriers associated with the advancement of an EBP in nursing. Some examples are associated with:  workloads, management that is not supportive of EBP,  lack of resources, lack of authority to change practices, and workplace culture that is resistant to change. PROF. REHAM KHRESHEH Facilitators of Evidence-Based Practice An organizational culture that encourages improved clinical outcomes through the promotion of clinical inquiry and evidence-based changes is an important place to begin. Some facilitating strategies include: (1) the support and encouragement of EBP projects from the leadership, (2) the sponsorship of relationships with mentors with excellent EBP skills, (3) the promotion of the use of the proper tools, such as computer-based best practice guidelines at the point of care, (4) the implementation of evidence-based clinical policies and procedures, and (5) the establishment of journal clubs PROF. REHAM KHRESHEH Any question? PROF. REHAM KHRESHEH