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  1. 1. Chapter 5 Evidence-Based Health Care
  2. 2. Objectives <ul><li>Upon completion of this chapter, the reader should be able to: </li></ul><ul><ul><li>Know the history of evidence-based care (EBC) in nursing </li></ul></ul><ul><ul><li>Develop an understanding of evidence and its use in decision making </li></ul></ul><ul><ul><li>Assume responsibility for developing an evidence-based approach to patient care </li></ul></ul>
  3. 3. Objectives <ul><ul><li>Understand the terminology used to describe types of evidence and evidence-based care processes </li></ul></ul><ul><ul><li>Develop an informed view of the current state of evidence-based care and an understanding of the role of nursing in evidence-based decision making </li></ul></ul><ul><ul><li>Apply the steps needed to incorporate evidence-based care in their own practice </li></ul></ul><ul><ul><li>Conduct a search for evidence on a given topic </li></ul></ul>
  4. 4. History of Evidence-Based Care <ul><li>Initially began in Canada </li></ul><ul><li>Evidence-based care </li></ul><ul><ul><li>The process of providing clinically competent care that is based on the best scientific evidence available </li></ul></ul><ul><li>Includes all health disciplines </li></ul>
  5. 5. Implementation of Evidence Practice <ul><li>Find a source of evidence-based content that is developed using good research techniques </li></ul><ul><li>The evidence-based content itself must be efficient for clinicians to use at the bedside </li></ul><ul><li>Integrate the evidence-based content into order sets, plans of care, and documentation forms </li></ul>
  6. 6. The ACE Star Model of Knowledge Transformation <ul><li>Provides a framework for systematically putting evidence-based practice into operation </li></ul><ul><li>Star points </li></ul><ul><ul><li>Knowledge discovery </li></ul></ul><ul><ul><li>Evidence summary </li></ul></ul><ul><ul><li>Translation into practice recommendations </li></ul></ul><ul><ul><li>Integration into practice </li></ul></ul><ul><ul><li>Evaluation </li></ul></ul>
  7. 7. Research Terminology <ul><li>Absolute benefit increase </li></ul><ul><li>Best practice </li></ul><ul><li>Case-control study </li></ul><ul><li>Clinical practice guidelines </li></ul><ul><li>Cohort study </li></ul><ul><li>Control group </li></ul><ul><li>Correlational research </li></ul><ul><li>Dependent variable </li></ul><ul><li>Descriptive research </li></ul><ul><li>Evidence-based health care </li></ul><ul><li>Follow-up study </li></ul><ul><li>Health outcomes </li></ul><ul><li>Independent variable </li></ul>
  8. 8. Research Terminology <ul><li>Integrative review </li></ul><ul><li>Longitudinal study </li></ul><ul><li>Matching </li></ul><ul><li>Meta-analysis </li></ul><ul><li>Nonexperimental research </li></ul><ul><li>Number needed to treat </li></ul><ul><li>Outcomes research </li></ul><ul><li>Prospective study </li></ul><ul><li>Qualitative analysis </li></ul><ul><li>Quantitative analysis </li></ul><ul><li>Quasi-experiment </li></ul><ul><li>Randomized clinical trial </li></ul><ul><li>Relative risk </li></ul><ul><li>Research utilization </li></ul>
  9. 9. Research Terminology <ul><li>Retrospective design </li></ul><ul><li>Systematic review </li></ul><ul><li>Time series design </li></ul><ul><li>Translation </li></ul><ul><li>Treatment effect </li></ul><ul><li>Variable </li></ul>
  10. 10. Importance of EBC <ul><li>There is a lack of agreed-upon standards or processes that are based on evidence </li></ul><ul><li>EBC is a process approach to collecting, reviewing, interpreting, critiquing, and evaluating research </li></ul><ul><li>Leads to a state-of-the-art integration of knowledge and evidence that can be evaluated and measured through outcomes </li></ul><ul><li>Should be viewed as the highest level of care </li></ul>
  11. 11. Nursing and EBC <ul><li>The agency for Healthcare Research and Quality (AHRQ) launched twelve evidence-based practice centers </li></ul><ul><li>The initiative partnered with public and private organizations to improve the quality, effectiveness, and appropriateness of care </li></ul><ul><li>Nurses work with patients in deciding treatment options </li></ul>
  12. 12. Attributes of EBC <ul><li>Need to define the meaning of evidence in each health care agency </li></ul><ul><ul><li>Use the term in daily practice </li></ul></ul><ul><ul><li>Look for best evidence when evaluating new goals and programs </li></ul></ul><ul><li>Fundamental principles in EBC </li></ul><ul><ul><li>Evidence alone is never sufficient to make a clinical decision </li></ul></ul><ul><ul><li>Evidence-based care involves a hierarchy of evidence to guide decision making </li></ul></ul>
  13. 13. Challenges for Nurses <ul><li>Rapidly growing body of scientific literature </li></ul><ul><ul><li>No unaided human being can read, recall, and act effectively on the volume of material </li></ul></ul><ul><li>Literature is not in a form that is suitable for application to practice </li></ul><ul><ul><li>Needs to be evaluated and transformed in order to be useful </li></ul></ul>
  14. 14. Conducting Evidence Reports in Nursing <ul><li>Select problem </li></ul><ul><li>Review the evidence </li></ul><ul><li>Summarize the evidence </li></ul><ul><li>Report results </li></ul><ul><li>Make recommendations for potential clinical applications </li></ul><ul><li>Implement agreed-upon practice changes </li></ul>
  15. 15. Promoting Evidence-Based Best Practices <ul><li>The U.S. health care system does not have uniform definitions of what constitutes efficient, effective, quality health care </li></ul><ul><li>It is difficult to get all clinical health care providers to apply EBC processes at the unit level </li></ul>
  16. 16. Promoting Evidence-Based Best Practices <ul><li>EBC processes must be uniform enough to be valid, but also adaptable to specific needs of institutions </li></ul><ul><li>EBC requires involvement of and collaboration between clinical practitioners and health care researchers </li></ul>