Module 7 - Evolving Trends in Evidence-Based Nursing Practice PDF

At the end of this session, the participants shall be able to; Discuss the Evidence-Based Practice around the world. Identify the supporting evidence-based practice. Explain the impact of Evidence-Based Practice in Nursing and the future ideas.  Anything that provides material...

At the end of this session, the participants shall be able to; Discuss the Evidence-Based Practice around the world. Identify the supporting evidence-based practice. Explain the impact of Evidence-Based Practice in Nursing and the future ideas.  Anything that provides material or information on which a conclusion or proof may be based; used to arrive at the truth, used to prove or disprove the point at issue. (Webster) Evidence-Based Practice (EBP) is conscientious, explicit and judicious use of current best evidence with clinical expertise, and patient values to make decisions about the care of patients. (Sackett, 2000)  Evidence-Based Nursing Practice is the process of shared decision-making between practitioner, patient and significant others, based on research evidence, the patient’s experiences and preferences, clinical expertise, and other robust sources of information. (STTI , 2007) EBP is both a process and a product… requiring that the evidence which is produced – is also applied to practice. (D. Rutledge, 2002)  Health care that is evidence-based and is conducted in a caring context leads to better clinical decisions and patient outcomes. Gaining knowledge and skills in the EBP process provides nurses and other clinicians the tools needed to take ownership of their practices and transform health care.  Traditions Borrowing Trial & Error Personal Experience Role Modelling Intuition Reasoning Research RESEARCH EVIDENCES PATIENT VALUES, Randomized controlled CIRCUMSTANCES trials CLINICAL EXPERTISE Laboratory experiments Unique preferences Clinical trials Knowledge gained from Concerns Epidemiological research practice over time Expectations Outcomes research Inductive reasoning Financial resources Qualitative research Social support Expert practice knowledge inductive reasoning  To provide the high quality and most cost efficient nursing care possible. To advance quality of care provided by health worker. To increase satisfaction among patients. To focus on nursing practice away from habits and tradition to evidence and research. It results in better patient outcomes. It contributes to the science of nursing. It keeps practice current and relevant. It increases confidence in decision making.  Find Evidence Evaluate the Developing a well Based resources strength and built question to answer the applicability of the (Ask) question evidence (Acquire) (Appraise) Evaluating the Applying the steps evidence (Audit) (Apply) Most nurses agree that EBP is important… but how do we make it happen?  Asking good clinical questions. Nurses must be empowered to ask critical questions in the spirit of looking for opportunities to improve nursing care and patient outcomes. Risk-taking environment.  Often more exploratory Less frequently focused on intervention selection Less evidence to support many nursing interventions Most nursing interventions have less capacity for harm Many nursing challenges often go beyond individual clinical interventions (e.g. nurse staffing, education, recruitment)  In postoperative patients, does prn or ATC analgesic administration yield better pain relief? Among critically ill patients, is controlled or open visitation more effective in reducing patient anxiety? Questions for Advanced Practice Nurses (APNs) In acute care hospitals, is the Clinical Nurse Specialist (CNS) more effective by focusing on a specific patient population or a specific unit? What kind of questions might the Nurse Manager ask? On medical-surgical units, do 12 hour or 8 hour shifts result in more medication errors? Objectives: To assess how nurse to patient ratios and nurse work hours were associated with patient outcomes in acute care hospitals Results: Higher RN staffing was associated with less mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other adverse events. Limited evidence suggests that the higher proportion of RNs with BSN degrees was associated with lower mortality and failure to rescue. More overtime hours were associated with an increase in hospital related mortality, nosocomial infections, shock, and bloodstream infections.  193. Alzheimer's Disease and Cognitive Decline 192. Lactose Intolerance and Health 190. Enhancing Use and Quality of Colorectal Cancer Screening 189. Exercise-induced Bronchoconstriction and Asthma 188. Impact of Consumer Health Informatics Applications 187. Treatment of Overactive Bladder in Women 185. Management of Ductal Carcinoma in Situ (DCIS) 184. Treatment of Common Hip Fractures 151. Nurse Staffing and Quality of Patient Care 140. Tobacco Use: Prevention, Cessation, and Control This is just one example of literature syntheses that are available to support EBP.  Scientific knowledge expansion - Knowledge expands exponentially Knowledge availability -- The Internet Highly educated nurses in clinical settings – - APNs – focusing on evidence-based clinical problem-solving - Clinical Nurse Researchers - Doctor of Nursing Practice (DNP) Movement Aggressive pursuit of cost-effectiveness Focus on quality of care, Risk & error reduction Highly educated consumers The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)/Accreditation expectations Increased attention to institutional image - Magnet hospital movement  Why have we always done “it” this way? Do we have evidence-based rationale? Or, is this practice merely based on tradition? Is there a better (more effective, faster, safer, less expensive, more comfortable) method? What approach does the patient (or the target group) prefer? What do experts in this specialty recommend? What methods are used by leading/benchmark, organizations? Do the findings of recent research suggest an alternative method? Are organizational barriers inhibiting the application of best practices in this situation? Is there a review of the research on this topic? Are there nationally recognized standards of care, practice guidelines, or protocols that apply?  Government agencies Cochrane Collaboration Professional Organizations Benchmark Institutions  AACN (American Association of Critical Care Nurse) AWHONN (Association of Women's Health, Obstetric and Neonatal Nurses) AORN (Association of perioperative Registered Nurses) ONS (The Office for National Statistics) Sigma Theta Tau  Evidence-based practice is every nurses’ responsibility. What can you do to make this goal a reality?  EB Education for EB Practice Base educational content on evidence Seek the most current forms of evidence, e.g. journals & online sources vs. texts Encourage students to question and challenge Teach research content in a manner that is interesting and useful  Encourage inquisitive minds Promote risk-taking and flexibility in the clinical environment Incorporate EBP activities into performance evaluations Provide time & resources unit internet access Provide support personnel Empower staff to make EB practice changes Acknowledge and reward EB improvements Remain clinically in touch Conduct clinically useful studies Support clinicians in accessing and synthesizing the evidence Collaborate with clinicians and patients Disseminate findings that are understandable and accessible Emphasize clinical implications  “Worry and Wonder” Be the Inquiring Mind Question clinical traditions Stay abreast of the literature- guidelines Find your niche – and become the expert Collaborate with APNs & researchers Be an advocate for evidence-based changes LISTEN to your PATIENTS – to guard patient & family preferences  Remove scope-of-practice barriers Expand opportunities for nurses to lead and diffuse collaborative improvement efforts Implement nurse residency programs Increase the proportion of nurses with a baccalaureate degree to 80% by 2020 Double the number of nurses with a doctorate by 2020 Ensure that nurses engage in lifelong learning Prepare and enable nurses to lead change to advance health Build an infrastructure for the collection and analysis of inter professional health care workforce data. International Organization for Migration(IOM)