LeMoyne.ppt

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LeMoyne.ppt

  1. 1. Evidence Based PracticeEvidence Based Practice for Nurses: Part 1for Nurses: Part 1 Angelique Jenks-BrownAngelique Jenks-Brown Interview Presentation at Le Moyne CollegeInterview Presentation at Le Moyne College December 2, 2004December 2, 2004
  2. 2. ObjectivesObjectives  Brief introduction to evidence based medicineBrief introduction to evidence based medicine  To construct a well-built questionTo construct a well-built question  Search techniques using MEDLINESearch techniques using MEDLINE  Obtaining articles at the libraryObtaining articles at the library
  3. 3. What is Evidence BasedWhat is Evidence Based Medicine (EBM)?Medicine (EBM)?  ““Conscientious, explicit, and judicious use ofConscientious, explicit, and judicious use of current best evidence in making decisionscurrent best evidence in making decisions about the care of individual patients. It meansabout the care of individual patients. It means integrating individual clinical expertise withintegrating individual clinical expertise with the best available external clinical evidencethe best available external clinical evidence from systematic research” - Sackett et. al.from systematic research” - Sackett et. al.  Clinical expertise + Patient values + BestClinical expertise + Patient values + Best evidence = Patient care decision makingevidence = Patient care decision making process of EBMprocess of EBM
  4. 4. How is EBN Different fromHow is EBN Different from EBM?EBM?  EBN stems from Evidence Based Practice,EBN stems from Evidence Based Practice, which is evidence-based methods of clinicalwhich is evidence-based methods of clinical decision making in healthcare practice.decision making in healthcare practice.  Nurses’ approach to Evidence Based PracticeNurses’ approach to Evidence Based Practice  Providing holistic careProviding holistic care  Acceptability to the patientAcceptability to the patient  Cost-effectivenessCost-effectiveness
  5. 5. Why learn Evidence BasedWhy learn Evidence Based Nursing (EBN)?Nursing (EBN)?  Nursing students’ preparation for criticalNursing students’ preparation for critical thinking skillsthinking skills  As an approach to managing the explosion ofAs an approach to managing the explosion of literatureliterature  To enrich nurses clinical training andTo enrich nurses clinical training and experience with up to date research.experience with up to date research.
  6. 6. Process of EBN: the Five “A’s”Process of EBN: the Five “A’s”  AskAsk  AcquireAcquire  AppraiseAppraise  ApplyApply  AssessAssess
  7. 7. AskAsk  Creation of a focused and structured questionCreation of a focused and structured question  Four parts to building a question:Four parts to building a question:  SituationSituation  InterventionIntervention  OutcomeOutcome  ComparisonComparison
  8. 8. ScenarioScenario  You are a school nurse who regularly visits aYou are a school nurse who regularly visits a number of elementary and middle schools innumber of elementary and middle schools in your region. It is cold and flu season onceyour region. It is cold and flu season once again. One of the teachers stops you in theagain. One of the teachers stops you in the hall to ask you a question about his 10-yearhall to ask you a question about his 10-year old daughter who also has a cold. He hasold daughter who also has a cold. He has heard that zinc lozenges can help to relieveheard that zinc lozenges can help to relieve cold symptoms and wonders if they really docold symptoms and wonders if they really do work and if it is OK to give them to children.work and if it is OK to give them to children.
  9. 9. Scenario QuestionScenario Question  In children with colds, are zinc lozenges safeIn children with colds, are zinc lozenges safe and effective for relief of cold symptoms?and effective for relief of cold symptoms?  Can you pick out the different parts of theCan you pick out the different parts of the question?question?  SituationSituation  InterventionIntervention  OutcomeOutcome
  10. 10. Scenario Question Difficulty?Scenario Question Difficulty?  Having trouble building a question? Use thisHaving trouble building a question? Use this question outline:question outline:  InIn this situationthis situation doesdoes interventionintervention oror a comparisona comparison affectaffect the outcomethe outcome??
  11. 11. Types of QuestionsTypes of Questions  DiagnosisDiagnosis  TherapyTherapy  PrognosisPrognosis  Etiology / HarmEtiology / Harm  Overview / Meta analysis / Systematic reviewsOverview / Meta analysis / Systematic reviews  Qualitative researchQualitative research
  12. 12. AcquireAcquire  Selecting resources and conducting the searchSelecting resources and conducting the search  ToolsTools  Journals and databases vs. the webJournals and databases vs. the web  DatabasesDatabases  JournalsJournals
  13. 13. Scenario SearchScenario Search  In children with colds, are zinc lozenges safeIn children with colds, are zinc lozenges safe and effective for relief of cold symptoms?and effective for relief of cold symptoms?  Type of Question?Type of Question?  Start search inStart search in MEDLINEMEDLINE
  14. 14. Scenario 2Scenario 2  You are a nursing administrator responsibleYou are a nursing administrator responsible for cutting the personnel budget with the leastfor cutting the personnel budget with the least amount of impact on patient care. Youamount of impact on patient care. You consider decreasing the number of RNs, and asconsider decreasing the number of RNs, and as an alternative you consider cutting unlicensecan alternative you consider cutting unlicensec assistive personnel.assistive personnel.
  15. 15. Scenario 2 Question & SearchScenario 2 Question & Search  Question: Will decreasing the number of RNsQuestion: Will decreasing the number of RNs versus UAPs have a low impact on patientversus UAPs have a low impact on patient care?care?  Question Type: QualitativeQuestion Type: Qualitative  Search Strategy:Search Strategy:  Nurses’ aides AND patient outcomes (textword)Nurses’ aides AND patient outcomes (textword)  Explode Nursing (MeSH) OR qualitative researchExplode Nursing (MeSH) OR qualitative research (textword) OR grounded theory (textword) OR(textword) OR grounded theory (textword) OR ethnograph* (textword)ethnograph* (textword)  Combine searchesCombine searches
  16. 16. Scenario 3Scenario 3  You are a nurse caring for a 28-year oldYou are a nurse caring for a 28-year old woman who has just had a D & C (dilation andwoman who has just had a D & C (dilation and curettage) following a spontaneouscurettage) following a spontaneous miscarriage. She was ten weeks pregnant andmiscarriage. She was ten weeks pregnant and this was her first pregnancy. In a teamthis was her first pregnancy. In a team meeting, one of your colleagues vaguelymeeting, one of your colleagues vaguely recalls seeing an article about grief afterrecalls seeing an article about grief after miscarriage and you decide to track it down tomiscarriage and you decide to track it down to determine whether your patient is at risk ofdetermine whether your patient is at risk of severe or prolonged grief.severe or prolonged grief.
  17. 17. Scenario 3 Question & SearchScenario 3 Question & Search  Question: In healthy women who have recently hadQuestion: In healthy women who have recently had a miscarriage, does the grieving process last longera miscarriage, does the grieving process last longer than usual?than usual?  Question Type: PrognosisQuestion Type: Prognosis  Search Strategy:Search Strategy:  Grief (textword) AND grief (subject heading)Grief (textword) AND grief (subject heading)  Pregnancy loss (textword) OR abortion (subject heading)Pregnancy loss (textword) OR abortion (subject heading)  Explode cohort studies (MeSH)Explode cohort studies (MeSH)  Combine searchesCombine searches
  18. 18. Scenario 4Scenario 4  You are a nurse practitioner in a primary careYou are a nurse practitioner in a primary care setting. You are familiar with a number ofsetting. You are familiar with a number of validated instruments to detect depression.validated instruments to detect depression. However, a colleague describes a two-questionHowever, a colleague describes a two-question instrument that she feels is as effective ininstrument that she feels is as effective in detecting probable cases of major depressiondetecting probable cases of major depression and would be much quicker to use. Youand would be much quicker to use. You decide to investigate the instrument and itsdecide to investigate the instrument and its properties further.properties further.
  19. 19. Scenario 4 Question & SearchScenario 4 Question & Search  Question: In patients with suspected depression,Question: In patients with suspected depression, is a two-question instrument or previouslyis a two-question instrument or previously validated instrument more accurate?validated instrument more accurate?  Question Type: DiagnosisQuestion Type: Diagnosis  Search Strategy:Search Strategy:  Deppression OR depressive disorder (textwords)Deppression OR depressive disorder (textwords)  Questionnaire AND sesitivity (textwords)Questionnaire AND sesitivity (textwords)  Primary care OR primary health care (textwords)Primary care OR primary health care (textwords)  Explode sensitivity and specificity (MeSH) ORExplode sensitivity and specificity (MeSH) OR predictive value* (textword)predictive value* (textword)  combinecombine
  20. 20. ResourcesResources  ““Evidence-Based Nursing” (2004). Center forEvidence-Based Nursing” (2004). Center for Evidence-Based Medicine at the University ofEvidence-Based Medicine at the University of Toronto Libraries. Last accessed 30 Nov. 2004 <Toronto Libraries. Last accessed 30 Nov. 2004 < http://www.cebm.utoronto.ca/syllabi/nur/http://www.cebm.utoronto.ca/syllabi/nur/ >.>.  ““Evidence Based Nursing Tutorial” (Sept. 2003).Evidence Based Nursing Tutorial” (Sept. 2003). University of North Carolina at Chapel Hill: HealthUniversity of North Carolina at Chapel Hill: Health Sciences Library. Last accessed 15 Nov. 2004 <Sciences Library. Last accessed 15 Nov. 2004 < http://www.hsl.unc.edu/Services/Tutorials/EBN/index.http://www.hsl.unc.edu/Services/Tutorials/EBN/index. htmhtm >.>.  Flemming, K. (1998). “Asking answerableFlemming, K. (1998). “Asking answerable questions”.questions”. Evidence-Based NursingEvidence-Based Nursing, 1(2), 36-37., 1(2), 36-37.
  21. 21. Resources cont.Resources cont.  Kessenich, C.R., Guyatt, G.H. & DiCenso, A.Kessenich, C.R., Guyatt, G.H. & DiCenso, A. (1997). “Teaching nursing students evidence-(1997). “Teaching nursing students evidence- based nursing”.based nursing”. Nurse EducatorNurse Educator, 22(6), 25-29., 22(6), 25-29.  McKibbon, K.A. & Marks, S. (1998)McKibbon, K.A. & Marks, S. (1998) “Searching for the best evidence. Part2:“Searching for the best evidence. Part2: searching CINAHL and Medline”.searching CINAHL and Medline”. Evidence-Evidence- Based NursingBased Nursing 1(4), 105-107.1(4), 105-107.  Richardson, W.S., et.al. (Nov-Dec 1995). TheRichardson, W.S., et.al. (Nov-Dec 1995). The well-built clinical question: a key to evidence-well-built clinical question: a key to evidence- based decisions”. ACP Journal Club, 123(3),based decisions”. ACP Journal Club, 123(3), A12-13.A12-13.
  22. 22. Resources cont.Resources cont.  Sackett, D.L. et.al. (1996). “Evidence basedSackett, D.L. et.al. (1996). “Evidence based medicine: What it is and what it isn’t”.medicine: What it is and what it isn’t”. BMJBMJ,, 312, 71-72.312, 71-72.  University of North Carolina at Chapel Hill,University of North Carolina at Chapel Hill, School of Information and Library Science.School of Information and Library Science. (Fall 2002 semester). Online course titled(Fall 2002 semester). Online course titled “Evidence Based Medicine”.“Evidence Based Medicine”.
  23. 23. Questions?Questions?
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