Chapter 2 Flashcards
definition according to David Eddy
David Eddy,one of the leaders of the movement, defined evidence-based medicine as “the conscientious, explicit,
and judicious use of current best evidence in making decisions about the care of individual patients”
the term evidence-
based practice has emerged as a descriptor of the
preferred approach to health care delivery.
Sigma Theta Tau International, the honor society for nurses, expanded this definition to address a broad nursing context with the following definition of evidence-based nursing practice:
the process of shared decision-making between practitioner, patient, and others significant to them based on research evidence, the patient’s experiences and preferences, clinical expertise or know-how, and other available robust sources of
information.
Historically, various industries, in health care and beyond, have used the term best practice to describe the strategies or methods that work most efficiently or achieve the best results. This concept is often associated with the process of benchmarking, which
involves identifying the most successful companies or institutions in a particular sector of an industry, examining their methods of doing business, using their approach as the goal or gold standard, and then replicating and refining their methods. Today, benchmarking data is one of the less scientific forms of evidence that is used, along with the results of formal research studies, to identify evidence based nursing practices.
Although this process of identifying the best evidence-based practices has become more scientific, the ultimate goal remains:
to provide optimal patient care, with the goal of enhancing nursing practice and, in turn, improving patient or system outcomes.
Why is evidence based practice important?
Provision of highest quality patient care
Control of health care costs
Patient satisfaction
When is evidence based practice important?
Value across nursing roles, responsibilities (incorporation into curricula; preparation of nurse leaders and administrators; staff nurses)
Where is evidence based practice important?
Worldwide commitment
Australia (the Joanna Briggs Institute)
Canada (Registered Nurses’ Association of Ontario)
Nursing Knowledge International (NKI): international clearinghouse, facilitator
True or False: The term evidence-based practice was first defined during the time of Florence Nightingale.
False:
Evidence-based practice emerged as a term in response to the ongoing expansion and demanding changes in health care.
It evolved when discussions of evidence-based medicine were expanded to include an interdisciplinary audience.
David Eddy, one of the leaders of the movement, defined evidence-based practice in 2005
How do nurses determine evidence based practice?
Evidence-based practice begins with questions that arise in practice settings. Nurses must be empowered to ask critical questions in the spirit of looking for opportunities to improve nursing practice and patient outcomes.
Each type of question can lead to
important decisions that affect outcomes, such as patient recovery, organizational effectiveness, and nursing competency.
The best answers and consequently the best decisions
come from informed, evidence-based analysis of each situation.
Key questions to ask when considering evidence based practices **
Why have we always done “ it” this way?
■ Do we have evidence-based rationale? Or is this practice merely based on tradition?
■ Is there a better (more effective, faster, safer, less expensive, more comfortable) method?
■ What approach does the patient (or the target group) prefer?
■ What do experts in this specialty recommend?
■ What methods are used by leading, or benchmark, organizations?
■ Do the findings of recent research suggest an alternative method?
■ Is there a review of the research on this topic?
■ Are there nationally recognized standards of care, practice guidelines, or protocols that apply?
■ Are organizational barriers inhibiting the application of evidence-based practice in this situation?
traditional based sources of evidence
Nurses rely on various sources to answer clinical questions such as those cited previously. A practicing staff nurse might consult a nurse with more experience, more education, or a higher level of authority to get help in answering such questions. Institutional standards or policy and procedure manuals are also a common reference source for nurses in practice. Nursing coworkers or other health care providers, such as physicians, pharmacists, or therapists, might also be consulted
Evidence-based sources of evidence
Research is generally considered a more reliable source of evidence than traditions or the clinical expertise of individuals. However, many experts argue that some types of research are better, or stronger, forms of evidence than others. In medicine and pharmacology, the randomized, controlled trial (RCT) has been considered the gold standard of clinical evidence. RCTs yield the strongest statistical evidence regarding the effectiveness of an intervention in comparison to another intervention or placebo. For many clinical questions in medicine and pharmacy, there may be multiple RCTs in the literature addressing a single question, such as the effectiveness of a particular drug. In such situations, an even stronger form of evidence is an integrative review or meta-analysis wherein the results of several similar research studies are combined or synthesized to provide the most comprehensive answer to the question. Practice-based evidence for continuous process improvement (PBE-CPI) incorporates the variation from routine clinical practice to determine what works best, for which patients, under what circumstances, and at what cost
Some of the additional sources are
Benchmarking data ■ Clinical expertise ■ Cost-effectiveness analyses ■ Infection control data ■ Medical record review data ■ National standards of care ■ Pathophysiologic data ■ Quality improvement data ■ Patient and family preferences
True or False: Institutional standards are considered evidence-based.
False: Institutional standards, procedure manuals typically considered sources for tradition-based evidence, rather than evidence-based information
Support Mechanisms for Best Evidence
Garner administrative support
Collaborate with research mentor (see Box 2.3)
Seek assistance from professional librarians
Search already reviewed or summarized research (journals, Cochrane Collaboration, AHRQ)
Access resources from professional organizations (AACN, AWHONN, AORN, ONS)
Benchmark with high-performing teams, units, institutions
Mechanisms for Incorporation into Practice
Development, refinement of research-based policies, procedures
Protocols, algorithms, decision trees, standards of care, critical pathways, care maps, institutional clinical practice guidelines
Consensus of interdisciplinary team
Patient, family support
Challenges to Implementation
Accessibility of research findings
Anticipated outcomes of using research
Support from others
Lack of organizational support (Funk, et.al, 1991, Retsas, 2000)
Setting often the greatest perceived barrier to research use (Karkos and Peters, 2006)
Which of the following would a nurse most likely need to address as the greatest obstacle when planning to implement evidence-based practice?
Accessibility of research findings
Support from others
Setting
Organizational support
Answer: Setting
Based on research about barriers to implementing evidence-based practice, setting is perceived to be the greatest barrier.
Accessibility of research findings, support from others, and lack of organizational support are also barriers.
None of these are considered to be the greatest barrier.
Support Mechanisms for Best Evidence
Garner administrative support
Collaborate with research mentor (see Box 2.3)
Seek assistance from professional librarians
Search already reviewed or summarized research (journals, Cochrane Collaboration, AHRQ)
Access resources from professional organizations (AACN, AWHONN, AORN, ONS)
Benchmark with high-performing teams, units, institutions
Mechanisms for Incorporation into Practice
Development, refinement of research-based policies, procedures
Protocols, algorithms, decision trees, standards of care, critical pathways, care maps, institutional clinical practice guidelines
Consensus of interdisciplinary team
Patient, family support
Challenges to Implementation
Accessibility of research findings
Anticipated outcomes of using research
Support from others
Lack of organizational support (Funk, et.al, 1991, Retsas, 2000)
Setting often the greatest perceived barrier to research use (Karkos and Peters, 2006)
