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Evidence Based Practice - Strategies to Nursing Practice

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Evidence Based Practice - Strategies to Nursing Practice

  1. 1. Evidence Based Practice Strategies to Nursing Practice L Anand, Lecturer, College of Nursing,NEIGRIHMS, Shillong
  2. 2. “ARE YOU SURE NEW BATH TECHNIQUE WAS ON THE EVIDENCED BASED PRACTICE LIST?”
  3. 3. EVIDENCE-BASED PRACTICE ?  Evidence-based practice is the integration of best research evidence with clinical expertise and patient values to facilitate clinical decision making.  Evidence-based clinical decision making should incorporate consideration of the patient’s clinical state, the clinical setting, and clinical circumstances.
  4. 4. The concept of EBP  EBP is a problem-solving approach to clinical decision making  EBP encourages critical thinking  EBP uses the latest research evidence to produce high quality health care.
  5. 5. The value of EBP  EBP ensures efficacy , efficiency and effectiveness.  EBP weighs risk, benefit, and cost against a backdrop of patient preferences.  promote patient satisfaction and higher health-related quality of life.
  6. 6. Models of EBP  The Johns Hopkins Nursing Evidence- Based Practice Model  The Ace Star Model (Stevens, 2005)  Lowa Model  Rosswurm and Larrabee Model.  Stetler Model.
  7. 7. Models of EBP
  8. 8. Models of EBP  Discovery  Summary  Translation  Integration  Evaluation
  9. 9. Process of EBP
  10. 10. N. MacIntyre, 2005 STEP 1: Identify an EBP question The process of forming an EBP question often begins when one of the following questions arises:  1. What evidence is the basis for this treatment?  2. Is there a scientific basis for this treatment?  3. What was the rationale for making that decision?  4. What are the clinical implications of this practice?
  11. 11. N. MacIntyre, 2005 STEP 1: Identify an EBP question  P Patient, population, or problem.  I Intervention or Interest  C Comparison intervention or status  O Outcome
  12. 12. PICO  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.
  13. 13. PICO  Comparison Intervention  Placebo, etc.  Outcome  Expected and actual effects on patient
  14. 14. PICO  Do nurse led tobacco cessation interventions result in decreased smoking rates after hospital admission for coronary heart disease?
  15. 15. PICO  PATIENT  (Adult) coronary heart patients  Smokers  Discharged from hospital  INTERVENTION  Nurse led tobacco cessation programmes
  16. 16. PICO  COMPARISON  (Non-nurse led tobacco cessation programmes  Self-administered, non-nurse administered, etc.)  No comparison  OUTCOME  Lower rates of tobacco use among Patient group
  17. 17. PICO  Not all questions are of a clinical nature  Intervention can be interpreted very broadly
  18. 18. N. MacIntyre, 2005 Sources of Evidence-Based Practice Problems
  19. 19. N. MacIntyre, 2005 Step 2: Define the scope of the practice question The problem or question may relate to the care of  an individual patient,  a specific population of patients, or  the general patient population in the organization.
  20. 20. N. MacIntyre, 2005 Step 3: Assign responsibility for leadership Step 4: Recruit an interdisciplinary team Step 5: Schedule a team conference
  21. 21. N. MacIntyre, 2005 STEP 6: Conduct an internal and external search for evidence  Preprocessed resources - materials that have been reviewed and chosen based on methodological standards for inclusion.  Primary evidence - usually data collected at the point of patient contact. This evidence can come from hospital-wide data, clinical trials, peer-reviewed research journals, conference reports, monographs, or summaries. 
  22. 22. N. MacIntyre, 2005 STEP 6: Conduct an internal and external search for evidence  Evidence summaries - synthesized literature and provide broader foci on topics. (systematic reviews, integrative reviews, book chapters, and meta- analyses).  Translation literature - quality-filtered Internet and Intranet sources(practice guidelines, critical pathways, care plans, clinical innovations, protocols, standards).
  23. 23. N. MacIntyre, 2005 STEP 6: Conduct an internal and external search for evidence  Evidence summaries - synthesized literature and provide broader foci on topics. (systematic reviews, integrative reviews, book chapters, and meta- analyses).  Translation literature - quality-filtered Internet and Intranet sources(practice guidelines, critical pathways, care plans, clinical innovations, protocols, standards).
  24. 24. N. MacIntyre, 2005 STEP 7: Appraise all types of evidence 
  25. 25. Claude Moore Health Sciences Library, 2003 Evidence Based Resources Models
  26. 26. SUNY Downstate Medical Center, 2003 Evidence Pyramid
  27. 27. Claude Moore Health Sciences Library, 2003 Evidence Based Resources Models
  28. 28. N. MacIntyre, 2005 STEP 8 – 10 : EBP STEP 8: Summarize the evidence STEP 9: Rate the strength of the evidence STEP 10: Develop recommendations for change in systems or processes of care based on the strength of the evidence
  29. 29. STEP 11: Determine the appropriateness and feasibility of translating recommendations into the specific practice setting The practice guidelines development cycle
  30. 30. N. MacIntyre, 2005 STEP 12 – 15 : EBP  STEP 12: Create an action plan  STEP 13: Implement the change  STEP 14: Evaluate outcomes  STEP 15: Report the results of the preliminary evaluation to decision makers
  31. 31. N. MacIntyre, 2005 STEP 12 – 18 : EBP STEP 16: Secure support from decision makers to implement the recommended change internally  STEP 17: Identify the next steps  STEP 18: Communicate the findings
  32. 32. Questions?

Editor's Notes

  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • So taking our previous equation,
    Search Protocol:
    The pyramid above is a graphical representation of how to search efficiently for the best evidence. The examples of EBM information sources in this pyramid are placed from top to bottom according to the "Usefulness of Medical Information" equation illustrated below:
    Usefulness =Relevance x Validity 
    Work
    This model suggests that you start your search at the top of the pyramid with systematic reviews from the Cochrane Database of Systematic Reviews. Cochrane is small in the amount of information it currently contains, making it easier to search, but large in the validity and relevance of the information it contains for answering therapeutic questions.
    Depending on the success of your search in Cochrane, you would work your way down the pyramid of resources in order of decreasing relevance/validity and increasing work, until you find an answer.
    Journal articles form the base of the pyramid because they represent large amounts of "unrefined" information, and the burden of determining the validity and relevance is up to the user. The work part of the "Usefulness Equation" is also very high for journal articles as it may require a lengthy MEDLINE database search to locate them.
    Searching and Alerting Tools:
    With the ever-growing number of pre-validated information sources available, clinicians now need two tools to help them identify information that is highly relevant and valid: an Alerting Tool and Searching Tool.
    A good Alerting Tool would notify the clinician whenever new relevant information becomes available. An example of such a tool would be Daily InfoPOEMs - a companion product to InfoRetriever (a searching tool) from the company InfoPOEMs: The Clinical Awareness System.
    A good Searching Tool would search multiple databases or sources of information simultaneously and present the results in an easy-to-use format based on relevance and validity.
    The pyramids below illustrate several such Searching Tools. Not all search tools are equal, and when using one it helps to evaluate it by asking the following questions:
    Does it search information sources that have a high usefulness score (higher on the pyramid)?
    Does it search multiple information sources simultaneously?
    Does it rank its search results according to usefulness (top of pyramid sources listed first)?
    Does it answer the highest percentage of questions in the least amount of time?
  • MEDLINE and the other online medical literature databases try to be as comprehensive as possible in their coverage. As a result, indexed material may have little direct application to present-day medical practice.
    The different types of material indexed in MEDLINE are labelled in the pyramid diagram, with the least clinically relevant at the bottom and the most clinically relevant at the top. The four layers above case reports and case series represent actual clinical research; the layers below are least clinically relevant and can be useful as background resources.
  • Here is how the tool applies to some of the Ovid databases. We have Cochrane at the top and Medline/CINAHL at the bottom.
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!
  • There are many definitions of Evidence Based Practice, a few of which I’m going to show you today. It is an approach to clinical practice which recognizes a few important facts:
    That scientific advances in medicine and nursing will not stop the day YOU graduate!
    That some studies have indicated it would take over 600 hours of reading every month to stay current with new developments
    By applying the concepts of evidence based practice you’ll get the evidence you need, when you need it!

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