Midterm Notes PDF

Lecture 1: Evidence Based Practise Why Evidence? -utilization of research by nurses in their practice -may also be called research based nursing practice, evidence based practice, evidence based decision making and **evidence informed practice** Development of Nursing Knowledge: -evidence from...

Lecture 1: Evidence Based Practise Why Evidence? -utilization of research by nurses in their practice -may also be called research based nursing practice, evidence based practice, evidence based decision making and **evidence informed practice** Development of Nursing Knowledge: -evidence from research, evidence informed theories, clinical experts and opinion leaders -evidence from assessment of patient's history and physical and available health care resources -clinical expertise -information about patient preferences and values -note that as you are documenting that information is being pooled Development of Nursing Knowledge -Quality and performance improvement: Similarities and Differences Among EIP, Research and QI **Evidence-Informed Decision Making** **Research** **Quality Improvement** -------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------- Purpose Use of information from research, professional experts, personal experience, and patient preferences to determine safe and effective nursing care with the goal of improving patient care and outcomes  Systematic inquiry answers questions, solves problems, and contributes to the generalizable knowledge base of nursing; it may or may not improve patient care.  Improves local work processes to improve patient outcomes and efficiency of health systems; results usually not generalizable  Focus Implementation of evidence already known into practice  Evidence is generated to find answers for questions that are not known about nursing practice.  Measures effects of practice and/or practice change on specific patient population  Data sources Multiple research studies, expert opinion, personal experience, patients  Participants have predefined characteristics that include or exclude them from the study; researcher collects and analyzes data from participants.  Data from patient records or patients who are in a specific area, such as on a patient care unit or admitted to a particular hospital  **Evidence-Informed Decision Making** **Research** **Quality Improvement** ------------------------------------------------- ----------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- Who conducts the activity?  Practising nurses and possibly other members of the health care team  Researchers who may or may not be employed by the health care agency and usually are not a part of the clinical health care team conduct it.  Employees of a health care agency, such as nurses, physicians, pharmacists  Is activity part of regular clinical practice?  Yes No Yes Is approval needed from an institutional research review ethics (REB) board?  Sometimes Yes Sometimes ------------------------------------------------------------------------------- ------------------------------------ ----------------------------------------------- ------------------------------------ Funding sources Internal, from health care agency  Funding is usually external, such as a grant  Internal, from health care agency  Importance of Evidence-Based Practice -Federally funded organizations created in 1990s to enable EBP decision making and policy: -1990- Nursing Health Services Research Unit (UofT and McMaster University) Development of Nursing Knowledge -Nursing knowledge must be expanded continuously -professional nurses must stay informed about current evidence -scientific literature in a book may be outdated Sources of evidence -scientific evidence in journals -non-research evidence, quality improvement, and risk management data -individual patient data and patients' values, beliefs and experience Researching the Evidence -- 5 Steps 1. Ask the clinical question -PICOT -- Format for Stating Clinical Questions: -P: patient population of interest -I: intervention of interest -C: comparison of interest -O: outcome -T: time 2. Collect the best evidence 3. Research literacy: critique the evidence 4. Integrate the evidence 5. Evaluate the practice decision or change Parts of A Research Report -Abstract -Introduction -Literature review or background -Manuscript narrative -Purpose statement -Methods or design -Results or conclusions -Clinical implications The History of Nursing Research in Canada -Florence Nightingale -University courses -Nursing research journals -Doctoral programs -Funding to support nursing research Nursing Research -a way to identify new knowledge, improve professional education and practice, and use resources effectively -some research tests nursing theories -theory generated from findings of other research -Research process: -begins with a researchable question -level of question determines the research design -literature search to discover what is already known about the topic -formulate research design steps -data collection (i.e. interviews, tests of knowledge, physiological measures) -analysis of evidence A diagram of a research process Description automatically generated \^Research Process Sources of Research Evidence -Systems: Sophisticated electronic systems 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 -Synopses of syntheses: Summaries of the findings from systematic reviews -Synopsis of single studies: A summary of the results and implications of single studies -Studies: Single research studies related to a particular focused question Research Designs -Quantitative research: -experimental research -descriptive designs -exploratory descriptive designs -data analysis -Qualitative research: Ethical Issues in Research -Rights of research participants -Research ethics board -informed consent -Principles -Respect for human dignity -Respect for persons -Concern for welfare -Respect for privacy and confidentiality -Justice Applying Research Findings in Nursing Practice -Research evidence -basis for decision making in clinical practice -essential for providing competent, efficient care -Nurses' needs -skills to access and appraise existing research WEEK 2: CHANGE Change -the act, process, or result of altering or modifying -most organization change is planned; is goal oriented and intentional Types of Change -**Personal change**: voluntary change with the goal of self-improvement i.e. altering diet for health reasons, taking classes for self-improvement or removing yourself from a destructive environment or situation -**Professional change:** deliberate change with the goal of improving professional ability/status i.e. change in position or job. This type of change is often planned. **-Organizational change:** mandated change with the goal of improving the organization's efficiency, this type of change causes the most stress or concern. Organizational change can also be defined as "an alteration of an organization's environment, structure, technology, or people", This type of change causes the most stress and concern. -[organizational change can affect 5 different aspects of organization:] 2)structure: ex. Authority relations, job design or similar variables [Traditional Change Theories ] **Lewin's Force Field Model 1951:** -three simple steps which are unfreezing (thawing of the current or old way of doing things), movement (the move to a new level), and refreezing (new ways of doing is incorporated into the routines or habits of the affected people) **Lippitt's Phase of Change 1958:** -built on Lewin's model -defined 7 stages in the change process (1)diagnosis of the problem (2) assessment of the motivation and capacity for change (3) assessment of the change agent's motivation and resources, (4) the selection of progressive change objectives, (5) choosing an appropriate role for the change agent (6) maintenance of the change once it has been started, and (7) termination of the helping relationship -emphasized participation of key personnel and the change agent in designing and planning the intended change project -also emphasized communication **Havelock's Six-Step Change Model 1973:** -6 step model of the change process -based on Lewin's model but has more steps in each stage -(1)building relationship, (2) diagnosing the problem, (3)acquiring resources \