Falls- Evidence-based Practice

Process to Practice Roxanne L. Ebo

An approach to clinical practice
A way to keep current with new developments
An integration of the best evidence available, nursing expertise, and the values and preferences of the individuals, families, and communities who are served.

… a methodological approach to clinical practice where evidence is used to inform decision-making about making a diagnosis (or interpreting a diagnostic test), selecting an intervention, or evaluating prognostic indicators

… an approach to health care practice in which the clinician is aware of the evidence that bears on her clinical practice, and the strength of that evidence

… an approach to decision making in which the clinician uses the best evidence available, in consultation with patient, to decide upon the option which suits that patient best

Evidence based health care
is
the integration of individual clinical expertise
with
the best available external clinical evidence and
the values and expectations of the patient

Involves life-long, self-directed, problem-based learning
Involves exploring the relationship between clinical reasoning and research evidence
Involves practice

Do nothing … and get out of date
Depend solely on courses/conferences
Choose the main professional journal(s) and read them cover to cover every month
Learn how to find and appraise the evidence to answer questions that come from clinical practice

Knowledge Standard
Each nurse possesses, through basic education and continuing learning, knowledge relevant to her/his professional practice

Knowledge Standard Indicators
Providing a theoretical and/or evidence-based rationale for all decisions
Understanding the knowledge required to meet the needs of complex clients
Knowing where/how to access learning resources when necessary

Knowledge Standard Indicators
Seeking and reviewing research in nursing, health sciences and related disciplines
Using research to inform practice/professional service

Knowledge Application Standard
Each nurse continually improves the application of professional knowledge

Knowledge Application Standard Indicators
Ensuring practice is based in theory and evidence and meets all relevant standards/guidelines
Assessing/describing the client situation using a theory, framework or evidence-based tool
Managing multiple nursing interventions simultaneously

Knowledge Application Standard Indicators
Evaluating/describing the outcome of specific interventions and modifying the plan/approach
Integrating research findings into professional service and practice

Thompson, C. et al. Evid Based Nurs 2004;7:68-72 The cognitive continuum.

Define the Question
Identify Question ~ Search and Screen Literature ~ Refine Question
Collect the Evidence
Critically Appraise the Evidence for Validity and Relevance

Integrate the Evidence and Patient Factors
Make & Carry Out the Decision
Evaluate the Process
Results ~ Self-reflection

A clinical question should incorporate at least three elements
Patient
Age, sex, ethnicity, etc.
Condition, diseases, general health status
Intervention
Education, diagnostics, treatment plan, self-care, etc.

Comparison Intervention
Placebo, etc.
Outcome
Expected and actual effects on patient

Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?

PATIENT
(Adult) coronary heart patients
Smokers
Discharged from hospital
INTERVENTION
Nurse led tobacco cessation programmes

COMPARISON
(Non-nurse led tobacco cessation programmes
Self-administered, non-nurse administered, etc.)
No comparison
OUTCOME
Lower rates of tobacco use among Patient group

Not all questions are of a clinical nature
Intervention can be interpreted very broadly

“ Important medical questions are typically studied more than once, often by different research teams in different locations. A meta-analysis combines results from different studies, hopefully averaging out any differences caused by random change or local variation and getting at something close to the real truth. In general a meta-analysis, if you can find one, will be a better guide to practice than an individual article. ”
SUNY Downstate Medical Center, 2003

Usefulness = Relevance x Validity
Work

http://medsurgmasters.wall.fm	10
http://medsurgmasters.wackwall.com	1
https://myclasses9.salisbury.edu	1

Falls- Evidence-based Practice

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