Chapter 13: Evidence-Based Practice Flashcards
WHAT IS EVIDENCE-BASED PRACTICE (EBP)?
Research studies
Systematic reviews of the literature
Intuition
Evidence from opinion leaders
The products of reasoning
Patient preferences
THE GROWTH OF EBP
A more suitable alternative to research alone for clinical decision making
Growth of scientific evidence in health care
Integration of evidence into guidelines for practice
Growth of information technology as a means to access data
A more informed public
Urgency of using evidence to improve practice is highlighted by Institute of Medicine reports
DECISION MAKING, PROBLEM SOLVING, OR CRITICAL THINKING
A disengaged, analytical, and objective process directed toward resolution of problems and achievement of clearly defined ends
CLINICAL JUDGMENT
Far more complex than critical thinking
Engaged practical reasoning
Recognition of pattern in the patient’s state
Subsequent intuitive clinical grasp of the
situation without evident forethought
Flexible, nuanced ability to read a situation
Preceded by clinical reasoning
CONCLUSIONS ON CLINICAL JUDGMENT
The clinician’s background is more influential on clinical judgment than objective data
Good clinical judgment requires knowing the patient and responding to his or her concerns
Clinical judgment is influenced by the context in which care occurs
Clinicians use a variety of clinical reasoning patterns alone or in combination
ANALYTIC REASONING
Deliberate, rational thought that includes generating alternatives, weighing options against evidence, and evaluating possible courses of action
Characteristic of a beginner or a more experienced clinician when stumped
Subject to biases and stereotypes
Diagnostic reasoning is an example of analytic thinking
INTUITION
Immediate grasping of a clinical situation
Function of familiarity with similar experiences
Judgment without a rationale
A form of pattern recognition rejecting conscious, linear analytic processes
NARRATIVE THINKING
Patient narratives provide us access to understand the experience of health and illness
Human motives, intents, and meanings are understood through narrative thinking
Narrative thinking is thinking through telling and interpreting stories
ENGAGED PRACTICAL REASONING
Recognition of a pattern or an intuitive grasp
Seeking, appraising, and implementing new knowledge prompted by uncertainty
Best course of action is not readily apparent
Openness to accept there may be different, and possibly more effective, methods of care
Weighing evidence against expectations, norms, and/or standards
REFLECTION
Analyzing the meaning of an experience
Identifying new information or alternative perspectives that can be helpful in future encounters
Connecting one’s actions to patient outcomes—an introspective process
ACCESSING AND EVALUATING RESEARCH EVIDENCE
Only a small fraction of the total research literature includes efficacy studies of clinical practice
Many clinicians do not know how to interpret the statistical results
NURSING COMPETENCIES THAT SUPPORT EBP
The ability to focus on outcomes
Asking answerable questions
Using the clinical literature
Appraising evidence from studies
APPRAISING EVIDENCE FROM STUDIES
Was there a clearly defined research question?
Was the assignment of patients to treatments randomized, and was the randomization list concealed?
Were all patients accounted for at its conclusion? Was there an “intention-to-treat” analysis?
Were research participants “blinded”?
Were the groups treated equally throughout?
Did randomization produce comparable groups at the start of the trial?
Are the results important?
How large is the treatment effect?
How precise is the finding from the trial?
APPLICABILITY OF EVIDENCE TO PRACTICE
Generalizability of results
Similarity of your patient to study population
CLINICAL AND RESEARCH LITERATURE
Medline
Appraising summaries
-Meta-analysis
-Integrative research reviews
Practice guidelines
Published summaries
