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  • Health care organizations find the journey to be a revealing self assessment, creating opportunity for organizational advancement, team building, and enhancement of individual professional self esteem.
  • Goal: engage the staff nurse to use the existing infrastructures to advance professional nursing practice in the organization.
  • Gena
  • Introduce me and Nicole Clinical Nurse Specialists in Critical Care Division Happy to have such an enthusiastic response to this first training session for CSI-EJ. Great representation from leadership , educators, and most importantly, from direct care-givers. As we all know, it is the nurse, the therapist, the dietician, the pharmacist who directly provides care to the patient who matters most in actually providing evidence based care and impacting patient outcomes. You are in the best position to consider the individual patient, his or her preferences and the best evidence in making decisions about their care . As you gain experience in the process, we hope that your compassionate care and clinical expertise will be enhanced by the increased investigative skills you will gain in this CSI training . We hope that you will find this to be a very practical boot camp in preparation for your role as a Clinical Detective.
  • Since we know that Effectiveness of the Auscultatory Method in Predicting Feeding Tube Location by Metheny was the main study that our guidelines and other reviews built their case on, we thought it would be a good one to take a critical look at. For today’s discussion, we’re going to spend an hour talking about this one really important study because we want to help you focus on finding specific clues and elements of a research article. On your unit, however, you may have everyone read 2 or 3 articles and discuss all of them within your one hour. (Or you may decide to do one article over 30 minutes.) There is no right or wrong answer-it’s about investigating to find the evidence that’s relevant to your practice. Since we’re spending an hour today, we put time frames in the L margin of your research article critique template, and we thought it might help to elect one member of your group timekeeper to keep you on track. The blank template for later doesn’t have any time frames on it, but it also has a spot for a timekeeper to keep you on track. You will need to plan ahead on how much time to spend on each section depending on your goals. Let’s get started…. How many people are at each table???Gena??? Could we just leave them there?

PPT PPT Presentation Transcript

  • Clinical Science Investigator’s Toolkit: An Evidence Based Practice Resource for the Bedside Nurse Beth Lacoste RN, APRN, CNS, MSN, CCRN Nicole Jones RN-BC, APRN, CNS-BC, MN, CCRN, CCNS Clinical Nurse Specialists, Critical Care Division East Jefferson General Hospital
  • The presenters have no financial or commercial conflicts of interest to disclose.
  • Objective:
    • At the end of this presentation, the participant will be able to :
    • Describe the development and implementation of a toolkit to engage bedside nurses in applying a model for EBP.
  • Evidence Based Practice What we had in place at EJGH:
    • Research Committee
    • EBP Model
    • EBP initiatives ongoing (quality improvement focused)
    • Center for Nursing Knowledge and Research
    • Doctoral prepared Nurse Researcher
    • ANCC Magnet re-designation survey 2006
    • Surveyor feedback:
      • It was evident that our practice was based on research, however, many staff nurses could not clearly articulate their involvement in EBP initiatives
  • With this valuable feedback our magnet journey continues.
  • Follow-up Center for Nursing Knowledge and Research
    • Nurse Researcher presented Unit-based introduction to EBP throughout the organization
    • Staff nurses were encouraged to initiate unit-based clinical inquiry Projects
    • Focus on staff level implementation of our existing EBP model
  • CNS Assessment of Staff Nurse Readiness:
    • What was needed was a practical tool to guide the staff nurse in the process of changing or confirming current practice based on evidence.
    • CNS Action:
    • The CSI toolkit was developed as a step-by-step guide to applying the EBP model.
  • EBP Toolkit
    • Intended for use by nurses with varied educational preparation
    • Serves to link the nurse with appropriate experts
    • Workbook that provides practical tips for how and when to consult the nurse researcher, Advanced Practice Nurse, Librarian and leadership resources during the investigation
    • Serves as a template for systematic documentation so that the findings and outcome of the process can be shared
  • Steps 1 and 2: Identify a Clinical Question and Clarification/Prioritization
    • Identifying a clinical problem
      • Record background, event, or data that led to this issue
    • Clarifying it in the form of a focused clinical question
    • Identifying other clinicians/leaders who may already be asking the same question
  • Step 2: Engage Stakeholders Calling all Detectives…..
  • Step 3: Evidence Review
    • First: Institutional Evidence
      • Search hospital intranet site for current policy/ procedure/ protocol
    • Second: Evidence-Based Practice Guidelines
      • Clinical Guidelines
        • Internet search www.guidelines.gov
        • Professional organization links on hospital intranet
    • Third: Research Literature
      • EBSCO, Ovid resources
    • “ People” EJGH Resources for Searching:
      • Hospital Librarian
      • Nurse Researcher (Dr. Bihm x 4854)
      • Clinical Educators (Center for Nursing Knowledge and Research x 4279)
      • Clinical Nurse Specialists in your area
    Step 3: Evidence Review Research / Literature
  • Step 4: Evidence Synthesis
    • Do we have GOOD EVIDENCE to answer our clinical question?
      No Yes Is the evidence applicable to your patient population and practice setting? No Yes Do we need a practice change?
    • See EBP Model
    • Consult Nurse Researcher
    • Discuss Findings
    • Consider Research
    No Yes Report Your Findings- Inform Go to Step VII Planning Practice Change Go to Step V
  • Levels of Evidence Comprehensive unbiased analysis using a strict scientific design to assess related studies Scholarly analysis of a body of research about a specific issue or topic Research studies in which treatment and control groups are randomly assigned “ gold standard of experimental design” Research studies where a design other than random sampling is used. Merged statistical results from a number of related studies Systematically developed statements by a group of experts to assist practitioner decisions
    • Meet with your leadership
      • How do we go about implementing this evidence into our hospital practice?
      • Should we:
        • Change an existing policy?
        • Create a new policy?
        • Purchase new equipment?
        • Do staff education?
      • Resource: Planning Practice Change Worksheet
    Step 5: Planning Practice Change
  • Step 6: Implement and Evaluate EBP Change
    • Record pertinent info about:
      • How and when you made the change
      • Any outcomes you might have measured following the change
      • Overall outcome of the change
  • Step 7: Inform and Integrate into Practice Standards
    • Make a poster to share the results of your investigation
    • Bring suggestions for policy changes to the appropriate Shared Governance Council
    • Bring your toolkit to the Center for Nursing Knowledge and Research – a copy will be made as a lasting resource
  • Encouraged staff to:
    • Be Creative
    • Share your CSI Journey
    • Convince others that the change is based on good evidence!
    • Help others bridge the gap between research and practice.
    • Consider presenting findings at a local or national conference.
  • CSI-EJ (Clinical Science Investigation)
  • Objectives At the end of today, you will be able to:
    • Apply the EJGH EBP Model in clinical practice.
    • 2. Gain skills to effectively search scientific literature using EJGH online resources.
    • 3. Evaluate literature for strength of evidence and applicability to practice.
    • Journal Club
    • Title
    • Date and Publication
    • Purpose
    • Setting
    • Population
    • Were the methods used logical and well carried out?
    • Was the study well designed?
    • Do you think the author’s conclusions are valid?
    • How does this study relate to your clinical population?
    Step 3 – Evidence Review Evidence Critique
  • EBP Detective Training Workshop Outcomes
    • Over 60 interdisciplinary team members attended
    • Identified areas for further education
    • Research Critique class offered – staff nurses and leadership attended
    • Statistics class planned for the future
  • Toolkit Evaluation
    • Many units have completed Clinical Science Investigations using the toolkit
    • EBP Day conducted to share results
      • Staff posters and completed toolkits
    • Toolkit presented at National Magnet and Critical Care Nurses Conferences
    • Ongoing use of the toolkit allows us to refine the toolkit as a resource to engage the bedside nurse in application of the EJGH EBP model.