EVIDENCE-BASED PSYCHIATRIC NURSING PRACTICE, Components of EPB BASES FOR NURSING PRACTICE, DEVELOPING EVIDENCE-BASED CARE, HIERARCHY OF RESEARCH EVIDENCE, TAXONOMY FOR INFORMED DECISION-MAKING, CHARACTERISTICS OF GOOD BEHAVIORAL HEALTH PRACTICE GUIDELINES, CLINICAL ALGORITHMS
Salient Features of India constitution especially power and functions
EVIDENCE-BASED PSYCHIATRIC NURSING PRACTICE
1. ..
SEMINAR ON EVIDENCE-BASED
PSYCHIATRIC NURSING PRACTICE
Presented by
Selvaraj.p
Ph.D Scholar
Oct-2019 Batch Guide
Dr.Sasi.Vaithilingan
Professor Cum Vice-Principal
VMCON Pondicherry.
2. OBJECTIVES
Define evidenced-based psychiatric nursing practice
Describe activities necessary for providing evidenced-based
psychiatric nursing practice.
Analyze practice guidelines and their contribution to clinical care
Examine the importance of outcome measurement in psychiatric
nursing practice
Articulate taxonomy for informed decision-making
State characteristics of good behavioral health practice guidelines
Understand Rhetoric and Reality
Evaluate the evidence-based for psychiatric nursing practice.
VMRF(DU) NSG 19 OCT 071/13/2021
3. INTRODUCTION
• During 1980s the term “evidence-based medicine”
emerged to describe the approach that used scientific
evidence to determine the best practice.
• Evidence based practice movement started in England
in the early 1990s
• Evidence-based medicine (EBM) or evidence based
practice (EBP), is the judicious use of the best current
evidence in making decisions about the care of the
individual patient. VMRF(DU) NSG 19 OCT 071/13/2021l
4. Con’t
• Evidence-based psychiatric care is a new way of
approaching the practice of psychiatric nursing,
• Research to make decisions about the care of individual
patients
• Evidence-based practice is also a method of self-
directed, career-long learning as the nurse continuously
seeks the best possible outcomes for patients through
implementing effective interventions based on well-
designed and carefully interpreted current research
studies VMRF(DU) NSG 19 OCT 071/13/2021
5. DEFINITIONS
• Evidence: It is something that furnishes proof or
testimony or something legally submitted to ascertain
in the truth of matter.
• Evidence based practice: It is systemic inter connecting
of scientifically generated evidence with the tacit
knowledge of the expert practitioner to achieve a
change in a particular practice for the benefit of a well-
defined client / patient group. (French 1999).
VMRF(DU) NSG 19 OCT 071/13/2021
6. • Evidence based nursing- it is a process by which nurses
make clinical decisions using the best available research
evidence, their clinical expertise and patient
preferences (mulhall, 1998)
• EBP in nursing is a way of providing nursing care that is
guided by the integration of the best available scientific
knowledge with nursing expertise. This approach
requires nurses to critically assess relevant scientific
data or research evidence and to implement high
quality interventions for their nursing practice. (NLM
PubMed) VMRF(DU) NSG 19 OCT 071/13/2021
8. ASSUMPTION
• It is risky to generalize from a small sample of patients
or a single case to the universe of patients.
• It is not possible to rule out other aspects of a situation
that may have caused the observed patient behavior
but which is not known to the clinician.
• Information gathered from clinical practice tends to
involve unsystematic observations.
• All clinicians have biases that influence clinical care.
VMRF(DU) NSG 19 OCT 071/13/2021
9. Con’t
• Even theories from respected colleagues must give
rise to testable hypotheses and evidence of efficacy
to be useful to clinical practice.
• Knowing that conclusions were reached through
scientific methodology permits a higher level of
confidence.
• Replication of findings increases confidence in their
validity. VMRF(DU) NSG 19 OCT 071/13/2021
10. Con’t
• Randomized controlled clinical trials (RCTs) are the
“gold standard” of research methods.
• Clinicians who are able to critically review the
research literature related to a specific clinical
question will be able to provide better psychiatric
care.
VMRF(DU) NSG 19 OCT 071/13/2021
11. BASES FOR NURSING PRACTICE
• The lowest level -rituals, unverified rules,
anecdotes, customs, opinions, and unit culture.
• The second level is the regulatory basis for practice
-state practice acts, accreditation, reimbursement,
and other regulatory requirements.
VMRF(DU) NSG 19 OCT 071/13/2021
12. Con’t
• The third level is the philosophical for -the mission,
values, and vision of the organization, professional
practice models, untested conceptual frameworks,
and ethical frameworks and professional codes.
• The fourth and highest level is evidence-based
practice -research findings, performance data, and
consensus recommendations of recognized experts.
VMRF(DU) NSG 19 OCT 071/13/2021
13. DEVELOPING EVIDENCE-BASED CARE
• Defining the clinical question
• The formulation of a precise clinical question-
defining the patient’s problems, identifying the
existing nursing intervention, and specifying the
expected outcome.
• Finding the evidence -. Most nurses rely on
textbooks, journal articles, and drug booklets to
help guide their practice.
VMRF(DU) NSG 19 OCT 07
1/13/2021
14. Con’t
• Electronic databases -MEDLINE, journals offer Web
pages on the Internet, displaying contents,
abstracts, and some full-text articles.
• A systematic reviewer -explicit methods of
searching for and critically appraising primary
studies
• A meta-analysis is the quantitative synthesis of the
results of a systematic overview of previous studies
VMRF(DU) NSG 19 OCT 071/13/2021
15. Con’t
• Analyzing the evidence -develop the ability to
understand and use appropriate research findings.
• This involves critical thinking skills and an
understanding of the nature of scientific inquiry to
be confident
• Evidence needs to be critically evaluated to
determine its reliability and whether it can be
applied to the particular clinical problem
VMRF(DU) NSG 19 OCT 071/13/2021
16. VARIABLES AFFECTING THE QUALITY OF
SCIENCE
• Selection of patients—included and excluded
• Blinding—of patients, of care providers, and of those
who assessed outcomes.
• Size of the study, a priori justification of sample size,
and consequent power.
• Therapeutic regimen—detailed information about the
treatment, the settings in which the services were
delivered, VMRF(DU) NSG 19 OCT 071/13/2021
17. Con’t
• Outcomes—choice of primary and secondary outcomes.
• Study administration, including length of follow-up.
• Withdrawals, dropouts, or other losses from the study,
by patient group.
• Confounders and bias and how they are accounted
• Statistical analyses—appropriateness of the statistical
model used; adequate description and reporting of the
analyses;
VMRF(DU) NSG 19 OCT 071/13/2021
18. HIERARCHY OF RESEARCH EVIDENCE
RANK
(HIGHEST TO
LOWEST)
EVIDENCE
Ia. A systematic review (meta analysis) of all relevant
randomized controlled trials (RCTs)
Ib. At least one properly designed randomized controlled trial
IIa. Well designed controlled trials without randomization
IIb. Well designed cohort, case controlled, or other
quasiexperimental study
III. Nonexperimental descriptive studies, such as comparative
studies
IV. Expert committee reports and opinions of respected
authorities based on clinical experience
IIa. Well designed controlled trials without randomization1/13/2021 VMRF(DU) NSG 19 OCT 07
19. QUESTIONS IN EVALUATING THE EVIDENCE
Type of
Questions
Type of evidence Questions
Experimental Is the practice efficacious when examined
experimentally?
Clinical Is the practice effective when applied clinically?
Safety Is the practice safe
Comparative Is it the best practice for the problem?
Rational Is the practice rational? Does it contribute to clinical and
scientific understanding?
Demand Do consumers and practitioners want the practice?
Satisfaction Is the practice meeting the expectations of patients and
clinicians?
Cost Is the practice cost-effective? Is it provided by payers?
VMRF(DU) NSG 19 OCT 071/13/2021
21. CHARACTERISTICS OF GOOD BEHAVIORAL
HEALTH PRACTICE GUIDELINES
• Developed in partnership with recipients,
consumers, family members, people in recovery,
and a wide range of disciplines and organizations.
• Clear, educational, and fully available to recipients,
consumers, families, people in recovery, all mental
health providers, and all payers.
• A toolbox of options and not prescriptive in nature.
VMRF(DU) NSG 19 OCT 071/13/2021
22. Con’t
• Flexible and accommodate consumer choice as well
as consumer values, goals, and desired outcomes.
• Sensitive and responsive to the individual’s
environment, ethnicity, culture, gender, sexual
orientation, and socioeconomic status.
• Scientific evidence of efficacy, effectiveness, and
established best practices in the field.
• Reviewed and updated regularly. VMRF(DU) NSG 19 OCT 07
1/13/2021
23. Con’t
• Incorporated into every practice guideline.
• Identify process and outcome measures, including
engagement in the treatment process, adherence,
continuity of care, symptom reduction, enhanced
quality of life,, integration of medical, psychiatric, and
substance abuse treatment, and improved social status
related to employment, housing, and school.
• Produce positive clinical outcomes that are sensitive to
time for quality improvement.
VMRF(DU) NSG 19 OCT 071/13/2021
24. QUESTIONS IN EVALUATING A PRACTICE
GUIDELINE
• Who wrote the guideline?
• Who sponsored the guideline?
• When was the guideline written?
• What methodology was used?
• Do the treatments recommended in the guideline
respect consumer rights?
VMRF(DU) NSG 19 OCT 071/13/2021
25. Con’t
• Are the treatments recommended in the guideline
affordable and accessible?
• Can the treatments be provided by a variety of
clinicians in various settings or are they limited in some
way?
• Was the guideline reviewed by a variety of groups,
including nurses and consumers?
• How does the guideline compare with other guidelines
in the field?
VMRF(DU) NSG 19 OCT 071/13/2021
26. CLINICAL ALGORITHMS
• Algorithms are rule-based deductive systems that
operate with inputs, sequences, time frames, and
outputs
• A clinical algorithm can be represented by a
diagrammatic flowchart that identifies what clinical
process might follow from a patient’s clinical status
and response to previous treatments
VMRF(DU) NSG 19 OCT 071/13/2021
28. RHETORIC OR REALITY
• RHETORIC: Psychiatric nursing can “hold its own” in
evidence-based models of practice and
interdisciplinary research.
• REALITY: There are no nursing evidence-based
models of psychotherapy, and little psychiatric
nursing research meets the “gold standard” in the
field.
VMRF(DU) NSG 19 OCT 071/13/2021
29. Con’t
• RHETORIC: Psychiatric nurses have a significant affect
on the nature, process, and outcomes of psychiatric
care.
• REALITY: Psychiatric nurses are not contributing to
evidence-based psychiatric care
• RHETORIC: Psychiatric nursing curricula reflect current
thinking in the field.
• REALITY: Evidence-based psychiatric care is not
normatively being taught in psychiatric nursing courses
and programs VMRF(DU) NSG 19 OCT 071/13/2021
30. BENEFITS OF EBP
• It use tools and therapies to help individuals
become more self-reliant and improve their quality
of life.
• Encouraging patients to improve their lifestyles,
relationships and become independent.
• Recovering addicts, for example, are encouraged to
seek peer and family support, learn their social and
environmental triggers, and work to avoid relapse
VMRF(DU) NSG 19 OCT 071/13/2021
31. EVIDENCE-BASED PRACTICE IN PSYCHIATRIC
NURSING
• Cognitive Behavioral Therapy (CBT)
• NAMI explains CBT as a therapy that helps
individuals discover the relationships that exists
between self-destructive behaviors and negative
thoughts and feelings. This type of psychotherapy is
an active intervention that seeks to positively
influence brain chemistry by changing the way you
think. VMRF(DU) NSG 19 OCT 071/13/2021
32. AUTISM
• Brian is a three year-old boy. He can often be found
playing with a single toy for hours on end, seeming to
not be aware of the world around him. He doesn't talk
like most three year-old children; in fact, he only says a
handful of words occasionally. His mother remembers
even when he was a baby, he didn't seem to respond to
cuddling or verbal interactions like most babies. A
couple months ago, Brian was diagnosed with autism.
VMRF(DU) NSG 19 OCT 071/13/2021
33. Evidence-Based Practices
• Research has proven that starting intensive
interventions for toddlers or preschoolers with
autism can help improve learning, communication,
and social skills.
• The guidelines for this intensive therapy include
having at least 25 hours a week of structured,
therapeutic activities.
VMRF(DU) NSG 19 OCT 071/13/2021
34. Con’t
• The program includes a multidisciplinary team
including a physician, speech-language pathologist,
and occupational therapist. The interventions are
focused on social skills, language and
communication, play skills and imitation, daily living
activities, and motor skills. They also incorporate
interactions with children without autism.
VMRF(DU) NSG 19 OCT 071/13/2021
35. EBP IN PSYCHIATRIC NURSING
• Cognitive Behavioral Therapy is useful for many disorders,
• Exposure therapy for anxiety, phobias and PTSD
• Functional family therapy for adolescents with problems
such as substance abuse
• Dialectical Behavior Therapy
• Motivational Interviewing
• Assertive community treatment is specialized care for
severe mental health disorders and illnesses
VMRF(DU) NSG 19 OCT 071/13/2021
36. EVIDENCED BASED TREATMENTS
• Medication treatment, evaluation and management
• Illness management and recovery
• Specialized psychotherapies
• Peer/consumer operated services and support
• Family psycho education
• Psychosocial rehabilitation
• Psychosocial rehabilitation
VMRF(DU) NSG 19 OCT 071/13/2021
37. Con’t
• Supported employment
• Permanent supportive housing
• Assertive community treatment
• Substance abuse treatment integrated with mental
health treatment
• Crisis/ hospital diversion programs
• Treatment of depression in older adults
• Mental health promotion
• Specific intervention for children and adolescents,
VMRF(DU) NSG 19 OCT 071/13/2021
38. CONCLUSIONS
• Many challenges face the specialty related to
evidence-based practice. Other mental health
professions are actively incorporating an evidence-
based approach into their clinical practice, training,
and research activity. The time has come for
psychiatric nursing to join in the challenge or
remain marginalized and excluded from being an
active, equal, and valuable member of the team.
VMRF(DU) NSG 19 OCT 071/13/2021
39. REFERENCES
1. Gail W Stuart, Principles and Practice of Psychiatric Nursing,
Elsevier publication, Newdelhi, 8th edition.
2. Gail W. Stuart, “Journal of the American Psychiatric Nurses
Association”. Vol. 7, No. 4 1078-3903. Page no- 103-111.)
doi:10.1067/mpn.2001.116352.
3. www.apna.org. August 2001
4. https://study.com/academy/lesson/evidence-based-
practice-in-psychiatric-nursing.html
5. https://dualdiagnosis.org/treatment-therapies-for-dual-
diagnosis-patients/evidence-based-treatment-practices/
VMRF(DU) NSG 19 OCT 071/13/2021
